Social Capital as a Mediator and Moderator in the Association between Loneliness and Health, Israel as a Case Study.

Loneliness has been associated with poor health. Social capital (SC) could possibly prevent the ill effects of loneliness. The study aims to assess the association of loneliness with physical and mental health in four different communities in Israel and study the impact of structural and cognitive SC on that association. A cross-sectional face-to-face survey with 4620 adults in four towns was conducted. The questionnaire included self-rated health (SRH), mental health (MH), loneliness, cognitive and structural SC and socioeconomic characteristics. Logistic regression analysis and mediation and moderation effects were calculated. Loneliness was associated with worse SRH (OR = 0.4-0.5) and worse MH (OR = 2.0-10). Both SC variables were associated with health. However, towns differ in these associations. Structural SC serves as a significant mediator between loneliness and SRH in all towns and is a mediator between loneliness and MH in two towns. Cognitive social capital was a moderator between loneliness and MH in two towns. This study suggests that increasing SC could possibly compensate for loneliness and buffer its effect on health. The study reinforces the need for the performance of separate health profiles to assess possible interventions for each community, as not always can we generalize these results to all communities.

Identifying the Gaps Between Public Health Training and Practice: A Workforce Competencies Comparative Analysis.

Objectives: The study aimed to generate insights on how best to enhance the compatibility between Public Health training program competencies and the implementation of competencies required by employers to address current and emerging public health needs. Methods: A survey adapted from the WHO-ASPHER Competency Framework for the Public Health Workforce was conducted online among Israeli public health managers from August to November 2021. The survey was formulated to mirror Essential Public Health Operations. Forty-nine managers participated (37.6% response rate) in an assessment of 44 public health competencies and the core organizational public health operations. Results: Analysis of Essential Public Health Operations revealed a notably high deficiency reported for Advocacy Communication and Social Mobilization for health competencies. Collaborations and Partnership and, Leadership and System Thinking were the most reported insufficient competencies, particularly in health departments and research institutes. Governmental offices reported Organizational Literacy and Adaptability competencies being deficient. Deficiencies were more impactful as the level of expertise increased. Conclusion: There is a clear need for public health professionals to acquire versatile and innovative competencies in response to the ever-changing health threats.

Ethnic Disparities in Social Capital and Health among Jewish and Arab Participants in the Israeli Mamanet Cachibol League.

The Israeli Mamanet Cachibol League (MCL) serves as a community model that incorporates physical activity and amateur team sports among women. Team sports have been shown to bridge gaps and build positive relationships between communities. There is a paucity of data regarding the advantages of team sports to promote the health and well-being of women from different ethnic backgrounds. The purpose of this study was to examine the association of participation in MCL with social capital, health, and well-being across two ethnic groups: Jewish and Arab women. A cross-sectional survey was conducted among women aged 25-64: 102 Jewish and 96 Arab MCL participants, and 102 Jewish and 81 Arab non-MCL participants. Data regarding social capital (trust, social support and social involvement) and well-being (self-reported health and psychosomatic and depressive symptoms) were analyzed using two-way analyses of covariance and multiple regression models with sequential entry of the variables. MCL participants from both ethnic groups reported higher social capital (p < 0.001), better self-reported health (p < 0.001), and lower psychosomatic symptoms (p < 0.001) compared to non-participants. Jewish MCL participants reported lower depressive symptoms (p < 0.001) than non-participants, however no difference was found between Arab MCL participants and non-participants (p < 0.160). Amateur team sports such as MCL are related with higher levels of well-being and social capital. Future research should focus on longitudinal studies that examine the change in social capital and well-being over time.

Health may be compromised by social interactions depending on culture among postpartum Arab and Jewish Israeli women.

BACKGROUND: Social support is generally perceived to facilitate health in postpartum women; however, previous research shows that this is not always true. Social interactions intended to provide support can be perceived as negative and in turn, may have negative impacts on maternal health. The purpose of the present study was to asses if social support and negative interactions at one month after childbirth can predict maternal health four months after childbirth, and if this relationship is influenced by culture. METHODS: This prospective longitudinal cohort study included randomly selected Arab (n = 203) and Jewish (n = 202) women who attended Mother and Child Health Clinics in Northern Israel one month after giving birth. The women were interviewed at one and four months after childbirth using a questionnaire including measures of health (self-reported health (SRH) and health problems), socioeconomic and demographic status, obstetric characteristics, social support, negative social interactions and perceptions of customs and traditions intended to help the mother cope after childbirth. Multivariable regressions were run to identify the variables predicting health four months after childbirth. RESULTS: The response rate for both interviews was 90%. Negative social interactions one month after childbirth significantly predicted health problems in Arab and Jewish women (Beta 0.20 and 0.37 respectively) and SRH among Arab women only (odds ratio (OR) 0.32, confidence interval (CI) 0.19-0.54) four months after childbirth. Social support at one month after childbirth significantly predicted better SRH in both Jewish and Arab women four months after childbirth (OR 2.33, CI 1.38-3.93 and 1.59, CI 1.01-2.46 respectively) and fewer health problems only among Jewish women (Beta - 0.37). CONCLUSIONS: Social support and negative social interactions appear to be predictive of health in postpartum women. Associations varied between Arabs and Jews, indicating that social support may be more important for predicting health among Jewish women and negative interactions may be more important among Arab women. Healthcare practitioners should be aware of the cultural context and social circumstances of postpartum women to ensure they receive the social support and care they need.

Different Reasons for Not Completing Routine Vaccinations Among Jewish and Arab Children in Israel.

Minority communities are at high risk for low childhood vaccination coverage rates. This paper compared the rate of children not fully vaccinated and the reasons for that between Jewish (majority) and Arab (minority) children in Israel. This cross-sectional study screened the medical files of 14,232 children (12,360 Jewish and 1872 Arab), registered at Mother-Child Health Clinics in two large geographical area, to identify children who did not complete the last dose of hepatitis B and DTaP or first dose of MMR vaccines. We compared the reasons for not completing the vaccine schedule registered by the nurses between Jewish and Arab children. We identified 1052 children who did not complete at least one of the vaccines: 975 Jewish children and 77 Arab children. Four causal categories were identified: medical reasons, parental decision, parental behaviour, and organizational reasons. Multinomial logistic regression analysis was performed to analyze the reasons for not completing the vaccination protocol. Arab children compared to Jewish children were more likely not to complete the vaccination protocol due to medical reasons (OR 3.81, CI 1.53-9.49) and less likely due to the reason parental decision (OR 0.35, CI 0.13-0.96). Therefore, patterns of reasons for not completing vaccinations vary, depending on population. Interventions to reduce the number of children not fully vaccinated should be tailored to the specific population.

A path analysis model suggesting the association between health locus of control and compliance with childhood vaccinations.

Despite vaccines benefits, parent's vaccine hesitancy is growing. Health locus of control (HLOC) may affect decision making regarding child vaccinations. The aim of this study was to investigate the relationship between parents' HLOC and compliance with routine childhood immunization programs. A cross-sectional survey was conducted among 731 parents of children aged 3-4 years. Internal HLOC, powerful others and chance HLOC (dimensions of external HLOC), reliability of information sources, and attitudes towards vaccines were measured. Path analysis was conducted to explore direct and indirect associations between HLOC and vaccination's compliance. The results show that High powerful others HLOC has a direct association with vaccination compliance (ß = 0.23, p < 0.001). High internal and chance HLOC have indirect associations through parents' attitudes regarding vaccines. Perceived reliability of information sources was associated with not complying with vaccines (ß = -0.07, p < 0.05). For conclusions, Interaction between internal and external HLOC may explain vaccination compliance. Decreasing levels of chance HLOC and increasing powerful others HLOC may increase levels of compliance with childhood vaccinations.

[SOCIAL-ECONOMIC-DEMOGRAPHIC DIFFERENCES IN REASONS NOT TO COMPLY IN TIME WITH ROUTINE CHILDHOOD VACCINATIONS].

BACKGROUND: In recent years, there has been an increase in parents who do not comply with recommended routine vaccines. The vaccination coverage rates in Israel are known, but the reasons for not completing immunizations are unknown. The aim of this study was to assess the extent of failure to complete the routine vaccinations in time and the reasons among different population groups. METHODS: This is a retrospective case-control cohort study, among children born in 2009. A total of 14,232 medical records of children who received services at Mother-Child Health Clinics were checked. The children who received all three core vaccines (3th Hepatitis B, 4th DTaP and MMR vaccines) were considered fully compliant and those missing at least one vaccination were considered non-compliant. Six reasons for not complying were identified: medical reasons, parental refusal to vaccinate, requests for a deferred schedule of vaccinations, parental behavior, organizational reasons and others. The differences between groups were analyzed by univariate analysis and logistic regression. RESULTS: In this study, 7.4% of children, were not fully compliant with all three core vaccines within two years. The main reasons in the Jewish population were: refusal and requests for variation in scheduling (44.3%) and in the Arabic population: parental behavior (40.8%). The risk for not completing the vaccinations was higher in children of Jewish mothers, residence in the Hadera sub-district, parents who had an academic education and older parents. CONCLUSIONS: There are differences between Arab and Jewish populations in the reasons for not complying in time with childhood vaccinations. In order to obtain herd immunity in the Israeli population, we need to tailor interventions suitable for each population group according to their characteristics.

The Relation Between Discrimination, Sense of Coherence and Health Varies According to Ethnicity: A Study Among Three Distinct Populations in Israel.

Self-reported experiences of discrimination and sense of coherence (SOC) have been found to be associated with health. A face-to-face survey of Long Term Jewish Residents (LTJR), Arabs and former Soviet Union (fSU) immigrants in Israel was performed. Respondents reported their physical and mental health, self-reported experiences of discrimination, SOC and socioeconomic status. Multivariable logistic regressions and bootstrapping path analyses were performed. Discrimination was associated with health after adjusting for all other variables. SOC was also associated with health. SOC did not mediate the strong association between discrimination and health among Israeli LTJR, but was a significant mediator among Arabs and fSU immigrants. Discrimination seems to have a direct effect on health only among the majority and not among minority populations. High levels of SOC may reduce the negative effects of discrimination on health by serving as a coping resource, however only among minorities.

The Association of Health Literacy with Health Behavior, Socioeconomic Indicators, and Self-Assessed Health From a National Adult Survey in Israel.

There is a growing need to understand how health literacy influences health outcomes in diverse populations. The aim of this study was to examine the relationship between health literacy, health behavior, sociodemographic indicators, and self-assessed health in the adult population in Israel while identifying populations at risk for low health literacy. A cross-sectional national survey was conducted among 600 adults randomly selected from a national database. The Health Literacy Survey-Europe-Q16 (HLS-EU-Q16) research instrument, adapted for use in Israel, was the basis for home interviews in Hebrew, Russian, and Arabic. Three levels of health literacy were distinguished: More than 31% of the sample had inadequate or problematic health literacy, and 69% showed likely sufficient health literacy. Logistic regression analyses showed that after we controlled for other determinants, years of education (ß = 1.8) and income (ß = 2.2) were significantly associated with health literacy. Multinomial logistic regression analysis showed that health literacy, along with age, was the strongest independent variable associated with self-assessed health. Thus, health literacy, strongly influenced by income and years of education, may play a key role in determining self-assessed health, a proxy health outcome, beyond sociodemographic variables. The study results contribute to understanding the role of health literacy in health disparities and identifying action areas for health promotion.

School Health Promotion Policies and Adolescent Risk Behaviors in Israel: A Multilevel Analysis.

BACKGROUND: Health promotion policies targeting risk-taking behaviors are being implemented across schools in Israel. This study identified the most effective components of these policies influencing cigarette smoking and alcohol consumption among adolescents. METHODS: Logistic hierarchical linear model (HLM) analysis of data for 5279 students in 95 Jewish public schools from the Health Behavior in School-Aged Children (HBSC) 2010-2011 survey in Israel enabled simultaneous estimation of the relationship between student- and school-level variables (health promotion policy) to alcohol consumption and smoking behavior. Principals of participating schools also were interviewed to ascertain their degree of adoption and implementation of a health promotion policy. RESULTS: Most of the variance in adolescent risk behaviors is explained by student-level variables: negative perceptions of school, lack of parental support for school issues, and more time spent with friends. Among the school-level policy measures, parental participation in health promotion intervention programs was repeatedly associated with lower rates of risk behaviors, over and above student characteristics. CONCLUSIONS: School health promotion policies should focus on parents' involvement in intervention programs and should seek to improve students' perceptions of school and their sense of well-being to promote resilience. Further research is needed to identify additional factors that may increase the effectiveness of school health promotion policies.

Lifestyle Behaviors Predict Negative and Positive Changes in Self-reported Health: The Role of Immigration to the United States for Koreans.

Studies of changes in health following immigration are inconsistent, and few are based on longitudinal designs to test associations based on change. This study identified factors that predicted changes in self-reported health (SRH) among California residents of Korean descent. A sample of California residents of Korean descent were interviewed and followed-up 2 or 3 times by telephone during 2001-2009. The questionnaires dealt with SRH, lifestyle behaviors (smoking, physical activity, and fast food consumption), and socioeconomic measures. Statistical analysis included random-intercepts longitudinal regression models predicting change in SRH. A similar percentage of respondents reported improved and deteriorating SRH (30.3% and 29.1%, respectively). Smoking, consumption of fast foods, age, percentage of life spent in the United States, and being female were predictors of deteriorating SRH, whereas physical activity, education, and living with a partner were predictive of improvement in SRH. The effect of immigration on SRH is influenced by socioeconomic factors and lifestyle practices. Results support promotion of healthy lifestyle practices among immigrants.

Personal needs versus national needs: public attitudes regarding health care priorities at the personal and national levels.

BACKGROUND: Many stakeholders have little or no confidence in the ability of the public to express their opinions on health policy issues. The claim often arises that lay people prioritize according to their own personal experiences and may lack the broad perspective necessary to understand the needs of the population at large. In order to test this claim empirically, this study compares the public's priorities regarding personal insurance to their priorities regarding allocation of national health resources. Thus, the study should shed light on the extent to which the public's priorities at the national level are a reflection of their priorities at the personal level. METHODS: A telephone survey was conducted with a representative sample of the Israeli adult population aged 18 and over (n = 1,225). The public's priorities were assessed by asking interviewees to assume that they were the Minister of Health and from this point of view allocate an additional budget among various health areas. Their priorities at the personal level were assessed by asking interviewees to choose preferred items for inclusion in their personal supplementary health insurance. RESULTS: Over half of the respondents (54%) expressed different personal and national priorities. In multivariable logistic analysis, "population group" was the only variable found to be statistically significant; Jews were 1.8 times more likely than Arabs to give a similar response to both questions. Income level was of borderline significance. CONCLUSIONS: At least half of the population was able to differentiate between their personal needs and national policy needs. We do not advocate a decision-making process based on polls or referendums. However, we believe that people should be allowed to express their priorities regarding national policy issues, and that decision-makers should consider these as one of the factors used to determine policy decisions.

Increased inequality in mortality from road crashes among Arabs and Jews in Israel.

OBJECTIVE: Previous studies in several countries have shown that the economically disadvantaged seem to have a greater risk of being involved in a car crash. The aim of the present study was to compare rates and trends in mortality and injury from road crashes by age among the Arab and Jewish populations in Israel. METHODS: Data on road crashes with casualties (2003-2011) from the Israeli Central Bureau of Statistics were analyzed. Age-adjusted road crash injury rates and mortality rates for 2003 to 2011 were calculated and time trends for each age group and population group are presented. Time trend significance was evaluated by linear regression models. RESULTS: Arabs in Israel are at increased risk of injury and mortality from road crashes compared to Jews. Road crash injury rates have significantly decreased in both populations over the last decade, although the rates have been persistently higher among Arabs. Road crash mortality rates have also decreased significantly in the Jewish population but not in the Arab population. This implies an increase in the disparity in mortality between Jews and Arabs. The most prominent differences in road crash injury and mortality rates between Arabs and Jews can be observed in young adults and young children. CONCLUSIONS: The reduction in road crashes in the last decade is a positive achievement. However, the reductions are not equal among Arabs and Jews in Israel. Therefore, an increase in the disparities in mortality from road crashes is apparent. Public health efforts need to focus specifically on decreasing road crashes in the Arab community.

The public's priorities in health services.

BACKGROUND: Rationing in health services cannot be solved only by cost-effective analysis because social values play a central role in the difficult trade-off dilemma of prioritizing some service over others. OBJECTIVE: To examine the relative importance ascribed by the public to selected components of health services, in the national allocation of resources as well as in their personal insurance. METHODS: A telephone survey of a representative sample of the Israeli adult population (N = 1225). Two versions of the questionnaire were used. At the national level, interviewees were asked to assume they were the Minister of Health. At the personal level, interviewees were asked to choose items to be included in their personal complementary health insurance. RESULTS: Check-ups for early disease detection and nursing care for the frail elderly got the highest support for extra budget as well as to be included in personal insurance. Other items presented were fertility treatments, cardiac rehabilitation, mental health, dental health, programmes for preventive medicine and health promotion, subsidizing supplemental insurance for the poor, additional staff for primary clinics and building a new hospital. The lowest support was for alternative medicine and for cosmetic surgery. No subgroup in the Israeli society presented a different first priority. CONCLUSION: The Israeli public does not give high priority to 'nice to have' services but their selections are 'mature' and responsible. Rationing in health care requires listening to the public even if there are still many methodological limitations on how to reflect the public's opinion.

Socioeconomic status and gender affects utilization of Medical Nutrition Therapy.

AIMS: To identify socioeconomic status and gender inequalities in long and short-term Medical Nutrition Therapy among Israeli adult patients with diabetes. METHODS: An analysis of data was performed on 90,900 patients over the age of 18 who were registered as patients with diabetes mellitus in Maccabi Healthcare Service Register which is the second largest health maintenance organization in Israel. Socioeconomic Rank for each patient was determined from the Israel Central Bureau of Statistics by geographical area of residence. Medical Nutrition Therapy was defined by the number of visits with registered dietitians. Short-term therapy was defined as one visit and long term therapy as two or more visits during the previous two years. Newly diagnosed patients were compared with veteran patients. RESULTS: Only 25.8% of the patients with diabetes received nutrition therapy during the previous two years. Newly diagnosed patients received therapy more frequently than veterans. We found that long term therapy was positively dependent on socioeconomic rank. Women under the age of seventy five had a higher chance of receiving therapy compared to men. CONCLUSIONS: A nationwide nutritional counseling service is available and accessible to all patients with diabetes. However, the patients with higher socioeconomic rank have a higher rate of persistence with long-term nutritional therapy.

Extreme and acquiescence bias in a bi-ethnic population.

BACKGROUND: Extreme and acquiescence biases are the tendency to give a positive or extreme answer regardless of the 'true' answer. These biases may compromise comparisons of attitudes regarding health between population groups. The aim of the study was to measure the extent of extreme and acquiescence biases and identify factors associated with them in two ethnic groups: Jews and Arabs in Israel. METHODS: A random telephone survey was conducted during 2006, interviewing 2322 Jews and 809 Arabs. Three attitude questions were presented twice with opposite wording to measure extreme and acquiescence biases in these two groups. RESULTS: Extreme bias ranged from 2 to 14% among Jews and from 6 to 29% among Arabs, depending on the question. Acquiescence bias ranged from 2 to 10% among Jews and 5-19% among Arabs. The less educated respondents gave more extreme biased responses for all items. The older respondents gave more extreme answers for two out of the three questions tested. After adjusting for age and education the odds ratio (OR) of giving more extreme biased answers was higher among Arabs compared with Jews for all three questions [OR = 2.49, confidence interval (CI) = 1.87, 3.31; OR = 2.33, CI = 1.75, 3.10; and OR = 2.94, CI = 1.83-4.71, respectively, for each question]. CONCLUSIONS: Levels of response biases are higher in the Arab minority population compared with the majority Jewish population and depended on the subject, age and education.

Persistent high rates of smoking among Israeli Arab males with concomitant decrease among Jews.

BACKGROUND: During the last few decades much effort has been invested into lowering smoking rates due to its heavy burden on the population's health and on costs for the health care services. OBJECTIVES: To compare trends in smoking rates between adult Arab men and Jewish men and women during 2000-2008. METHODS: Six random telephone surveys were conducted by the Israel Center for Disease Control in 2000-2008 to investigate smoking rates. The number of respondents was 24,976 Jewish men and women and 2564 Arab men. The percent of respondents reporting being current smokers was calculated for each population group (Jews and Arabs) by age, gender and education, and were studied in relation to time. RESULTS: Among Jewish men aged 21-64 smoking declined during 2000-2008 by about 3.5%. In the 21-44 age group this decline occurred only among respondents with an academic education. Among Jewish women this decline also occurred at ages 21-64, and in the 45-64 age group this decline was due only to a decline in smoking among those with an academic education. Among Arab men aged 21-64 an increase in smoking rates of about 6.5% was observed among both educated and less educated respondents. CONCLUSIONS: Smoking prevalence is declining in Israel among Jews, but not among Arab men. The larger decrease in smoking rates among academics will, in the future, add to the inequalities in health between the lower and higher socioeconomic status groups and between Arabs and Jews. This calls for tailored interventions among the less educated Jews and all Arab men.

Can subjective and objective socioeconomic status explain minority health disparities in Israel?

Disparities in health exist between the three main population groups in Israel, non-immigrant Jews, immigrants from the former Soviet Union (arriving in Israel since 1990) and Arabs. This study examines the relationship between health and socioeconomic status in this multicultural population and assesses to what extent subjective and objective socioeconomic measures may explain the disparities in health. A random cross sectional telephone survey of 1004 Israelis aged 35-65 was performed. The questionnaire measured physical and mental health-related quality of life using the Short Form 12. Information regarding subjective socioeconomic status (SSS) and objective socioeconomic status (SES) was collected. Arabs and immigrant women from the former Soviet Union had worse physical health compared to non-immigrant Jews. Immigrant and Arab men and women had worse mental health compared to non-immigrant Jews. Multivariable log-linear regression analysis adjusting for age, SSS or SES explained the disparities in physical health between Arab and non-immigrant Jewish men. However, SSS and SES did not explain the disparities in physical health between the three groups of women. The disparities in mental health between immigrants and non-immigrant Jews can be explained by SSS for both men and women, whereas the disparities between Arabs and Jews can be explained by objective SES only among women. Employed men reported better physical and mental health. Part of the disparities in mental health in Israel can be attributed to differences in SSS and SES in the different groups. However, there is a need to identify additional factors that may add to the disparities in both physical and mental health. The disparities due to socioeconomic status vary by health measure and population group.

Reducing disparities in mammography-use in a multicultural population in Israel.

BACKGROUND: In the past mammography-use has been reported to be low in Israel compared to other western countries. The objectives of this study were (1) to assess the increase in mammography-use during the years 2002 to 2007 in four population groups in Maccabi Healthcare Services (MHS), Israel: non-immigrant non-ultraorthodox, ultraorthodox, and immigrant Jewish women and Arab women; (2) to assess ethnic and socioeconomic disparities in mammography-use. METHODS: A random telephone survey of 1,550 women receiving healthcare services from MHS was performed during May-June 2007. Information from MHS claims-records database regarding mammography-use was obtained for each woman for the period 2002 to 2007. Since mammography-use serves as a quality assurance measure for primary care, MHS sent mail and telephone invitations for mammography to all women since the end of 2004. RESULTS: At the beginning of the follow-up period (2002) mammography-use among Jewish non-immigrant non-ultraorthodox and ultraorthodox women was higher than among Arab and Jewish immigrant women. During the 5 year follow-up these disparities decreased significantly. In 2007, mammography-use by Arab women was only slightly lower compared to all groups of Jewish women. In 2007, after adjustment for socioeconomic factors there was only a borderline significant difference between Jewish and Arab women. The socioeconomic variables were not associated with mammography-use in 2002 and 2007 in any of the groups except for marital status in immigrant women in 2002. CONCLUSION: The interventions implemented by MHS may have increased mammography-use in all population groups, decreasing disparities between the groups, however the differences between Jewish and Arab women have not been completely eliminated and indicate a need for further targeted interventions. No significant socioeconomic disparities in mammography-use were observed.

[Patterns of utilization of healthcare services among immigrants to Israel from the former Soviet Union].

BACKGROUND: Contradictory evidence exists as to the rate of use of healthcare services by Israeli immigrants from the former Soviet Union (fSU). OBJECTIVES: The aim of this study was to compare the rates of utilization of healthcare services in veteran Israeli Jews and immigrants a decade and a half after immigration. METHODS: The data was obtained from the Israel National Health Interview Survey (INHIS) during 2003-2004, which is based on 6,756 interviews with veteran Israeli Jews and 953 interviews with immigrants from the fSU, of them 835 arrived in Israel during the years 1990-1998, and 118 arrived after 1998. Questions included use of healthcare services, health status and socioeconomic factors. RESULTS: The immigrants from the fSU reported similar rates of visiting a family physician and specialist and lower hospitalization rates after adjustment for socioeconomic variables compared to veteran Jews. However, the rate of use of preventive tests such as serum cholesterol tests, mammography and Pap smear tests was lower in immigrants. There was no significant difference in use of healthcare services between recent immigrants and those living in Israel more than 5 years, except for mammography performance. CONCLUSIONS: The use of community healthcare services among immigrants is similar to the use among veteran Jews. However, the immigrant population in Israel utilizes preventive services less often than the veteran Jewish population.