Factors associated with attempting and succeeding in smoking cessation following a National Tobacco Control Plan: Analysis of two nationwide surveys (2010 and 2017).

INTRODUCTION: Lower rates of smoking cessation among disadvantaged groups contribute to widening health-disparities. With this recognition, in 2010 free-of-charge/subsidized smoking cessation services became available to all Israeli residents through the not-for-profit health plans. METHODS: Based on two cross-sectional National Social Surveys, data on adult ever-smokers were used (n = 2,998 in 2010 and 2,859 in 2017). The outcome variable comprised three categories: no quit attempt, unsuccessful quit attempt and successful quit attempt. Changes over-time and demographic, socioeconomic, health- and smoking-related factors associated with quitting attempts and success were tested in the pooled sample, using multivariable multinomial logistic regression models. RESULTS: The pooled sample of the two surveys included 2,611 participants (44.2%) who were successful quitters, 1,941 (32.7%) who reported an unsuccessful quit attempt, and 1,305 (23.1%) smokers who did not attempt to quit. Compared to 2010, ever-smokers in 2017 were less likely to report an unsuccessful quit attempt (adjusted OR = 0.81, 95%CI: 0.70-0.94). The likelihood of successfully quitting was similar in both surveys. Older age and self-reported health problem were associated with higher likelihood of quitting attempt. Meeting living expenses, being overweight/obese, engaging in physical activity and heavy smoking were associated with higher likelihood of successful smoking cessation; while environmental tobacco exposure was associated with 43% lower likelihood of successful cessation. Finally, there was an interaction between education and ethnicity. Higher education level was associated with a greater likelihood both to attempt to quit smoking and to succeed among Jewish participants, while the opposite phenomenon was observed among Arab smokers. CONCLUSIONS: Despite the availability of subsidized smoking cessation services, social disparities in smoking cessation rates persist. Efforts should focus on proactively reaching subpopulations with low cessation rates, using tailored strategies for successful smoking cessation. Promoting smoke free homes and workplaces should be prioritized.

Factors associated with disparities in out-of-pocket expenditure on dental care: results from two cross-sectional national surveys.

BACKGROUND: Socioeconomic differences in oral health and dental care utilization are a persistent problem in many high-income countries. We evaluated demographic, geographic and socioeconomic factors associated with disparities in households' out-of-pocket expenditure (OOPE) on dental care, and the effect of ongoing dental health reform on these disparities. METHODS: This cross-sectional analysis used data collected in two Israeli Household Expenditure Surveys conducted in 2014 and 2018. OOPE for dental care was estimated using a two-part multivariable model. A logistic regression was used to examine the likelihood of reporting any OOPE, and a log-transformed linear regression model examined the level of expenditure among those who reported any OOPE. RESULTS: In 2018, OOPE on dental care accounted for 22% of total health expenditure for all households, whereas among those who reported dental OOPE it reached 43%. Households with children up to age 14 years reported lower OOPE, regardless of ownership of supplementary health insurance. Owning supplementary health insurance had a heterogeneous effect on the level of OOPE, with a significant increase among those with 0-8 years of education, compared to households without such insurance, but not among those of higher educational level. In 2014, Arab ethnic minority and residence in the country periphery were associated with a greater likelihood for any OOPE and higher amounts of OOPE on dental care. While the gaps between Jewish and Arab households persisted into 2018, those between peripheral and non-peripheral localities seem to have narrowed. CONCLUSIONS: The burden of dental OOPE on Israeli households remains heavy and some disparities still exist, even after the implementation of the dental health reform. Expanding the dental health reform and addressing barriers to preventive dental care, especially among Arabs and those of lower educational level, may help in reducing households' private expenses on dental care.

Cardiovascular health among two ethnic groups living in the same region: A population-based study.

BACKGROUND: Poor cardiovascular health (CVH) among ethnic/racial minorities, studied primarily in the USA, may reflect lower access to healthcare. We examined factors associated with minority CVH in a setting of universal access to healthcare. METHODS AND RESULTS: CVH behaviors and factors were evaluated in a random population sample (551 Arabs, 553 Jews) stratified by sex, ethnicity and age. More Jews (10%) than Arabs (3%) had 3 ideal health behaviors. Only one participant had all four. Although ideal diet was rare (≤1.5%) across groups, Arabs were more likely to meet intake recommendations for whole grains, but less likely to meet intake recommendations for fruits/vegetables and fish. Arabs had lower odds of attaining ideal levels for body mass index and physical activity. Smoking prevalence was 57% among Arab men and 6% among Arab women. Having four ideal health factors (cholesterol, blood pressure, glucose, smoking) was observed in 2% and 8% of Arab and Jewish men, respectively, and 13% of Arab and Jewish women. Higher prevalence of ideal total-cholesterol corresponded to lower high-density lipoprotein cholesterol among Arabs. No participant met ideal levels for all 7 metrics and only 1.8% presented with 6. Accounting for age and lower socioeconomic status, Arabs were less likely to meet a greater number of metric goals (odds ratio (95% confidence interval): 0.62 (0.42-0.92) for men, and 0.73 (0.48-1.12) for women). CONCLUSIONS: Ideal CVH, rare altogether, was less prevalent among the Arab minority albeit universal access to healthcare. Health behaviors were the main contributors to the CVH disparity.

Social characteristics associated with disparities in smoking rates in Israel.

BACKGROUND: Cigarette smoking is a major cause of health disparities. We aimed to determine social characteristics associated with smoking status and age at smoking initiation in the ethnically-diverse population of Israel. METHODS: This is a cross-sectional survey, based on data collected during 2010 by the Israel Bureau of Statistics, in a representative nationwide sample of 7,524 adults (≥20 years). Information collected by personal interviews included a broad set of demographic and socio-economic characteristics and detailed information on smoking habits. Associations between social characteristics and smoking habits were tested in multivariable regression models. RESULTS: Current smoking was more frequent among men than among women (30.9 % vs. 16.8 %; p < 0.0001). In multivariable regression analysis, the association of some social characteristics with smoking status differed by gender. Lower socioeconomic status (reflected by higher rate of unemployment, lower income, possession of fewer material assets, difficulty to meet living expenses) and lower educational level were significantly associated with current smoking among men but not among women. Family status other than being married was associated with higher likelihood of being a current smoker, while being traditional or observant was associated with a lower likelihood of ever smoking among both gender groups. Arab minority men and male immigrants from the former Soviet Union countries were more frequently current smokers than Israeli-born Jewish men [adjusted odds ratio (95 % confidence interval): 1.53 (1.22, 1.93) and 1.37 (1.01-1.87), respectively]. Compared to Israeli-born men, the age at smoking initiation was younger among male immigrants, and older among Arab minority men [adjusted hazard ratio (95 % confidence interval): 1.360 (1.165-1.586), and 0.849 (0.749-0.962), respectively]. While the prevalence of current smoking was lower in younger birth cohorts, the age at smoking initiation among ever-smokers declined as well. CONCLUSIONS: Among several subgroups within the Israeli population the smoking uptake is high, e.g. Arab men, men who are less affluent, who have lower educational level, and male immigrants. These subgroups should be prioritized for intervention to reduce the burden of smoking. To be effective, gender, cultural background and socioeconomic characteristics should be considered in the design and implementation of culturally-congruent tobacco control and smoking prevention and cessation interventions.

Identification of health care needs of long-term breast cancer survivors among Israeli women.

PURPOSE: Improvement in treatment has extended survival of breast cancer patients. Our study aimed to characterize health service use among long-term breast cancer survivors in Israel in order to identify and address specific needs of this subpopulation. METHODS: The study population included 250 women diagnosed with breast cancer, 8-12 years prior to study initiation (cases), and 250 individually matched cancer-free controls. Participants were recruited from the second largest Israeli HMO, and data were collected through personal interviews. ORs and 95 % CIs were estimated using conditional logistic regression and generalized estimating equations. RESULTS: Greater use of health services was observed among cases, compared to an age-matched comparison group, expressed by more visits to family physicians and specialists, longer duration of visits, more requests for referrals, more frequent contact with emergency services, and hospitalizations. The study groups were similar regarding socioeconomic variables, current smoking and physical activity, BMI, and prevalence of reported morbidity. Although 80 % of cases defined the family physician as their main treating physician, half still considered their oncologist responsible for cancer follow-up. Only 14.4 and 10.4 % of cases and controls, respectively, reported receiving psychological support during the year preceding the interview. CONCLUSIONS: Further studies should assess the contribution of apprehension concerning health-related issues that still accompany breast cancer survivors, to the excess use of health services. Concern among family practitioners may contribute as well. In addition, our results emphasize the need to improve coordination between the disciplines of oncology and community medicine for the medical care of this group.

Patterns of drug use among the community-dwelling old-old population in Israel.

BACKGROUND: Due to multiple chronic illness and disability, the elderly consume a disproportionately large share of medications. OBJECTIVES: To assess the patterns and determinants of drug use among the community dwelling old-old population. METHODS: The study population included 1,369 old-old persons from the baseline data of the Cross-Sectional and Longitudinal Aging Study (CALAS), which is based on a national random stratified sample of the Israeli Jewish population aged 75-94 years. RESULTS: The mean number of drugs used by the study population was 3.3, and only 12.5% did not consume any drugs, Multivariate linear regression analysis showed that women used significantly more drugs than men, and that those born in Europe took significantly more drugs than those born in Israel and Asia-Africa. The number of medical conditions was the strongest predictor of drug use. Hospitalizations during the last year and frequent visits to family physician were also significant factors related to drug use. All variables combined explained 40% of the variance in drug use by the old-old. The most commonly used therapeutic groups were cardiovascular drugs (53%), psychotropic drugs (31%), analgesics (30%), and gastrointestinal drugs (28%). CONCLUSIONS: Our data indicate that in addition to the association of drug use with health status and healthcare utilization, the number and type of drugs taken vary with gender and place of birth.

The role of sonographic assessment of cervical length in the prediction of preterm birth in primigravidae with twin gestation conceived after infertility treatment.

OBJECTIVE: To identify the risk factors for preterm birth in primigravidae with twin gestation and the role of transvaginal ultrasonographic assessment of the cervix. METHODS: Between January 1996 and December 1996, 54 twin pregnancies were prospectively enrolled. All women were at their first pregnancy. All women conceived following infertility treatments and all had a normal uterine cavity proven by hysterosalpingography (HSG) or hysteroscopy. Multiple logistic regression analysis was used to evaluate the association between the length of the cervix at 18-24 weeks of gestation and outcome variables, controlling for possible confounding factors. RESULTS: The mean +/- SD maternal age was 30.9 +/- 5.3 years (range 22-46), and five of them were aged 40 or more. Nine patients (20.5%) delivered prematurely, defined as spontaneous delivery at or before 34 weeks of gestation. There was no statistically significant difference between women who delivered before or after 34 weeks of gestation in regard to maternal age, body mass index (BMI), weight gain in pregnancy, smoking and work during pregnancy. The mean cervical length of patients who delivered before 34 weeks of gestation (30.1 +/- 6.1 mm) was significantly shorter than that of women who delivered after 34 weeks of gestation (42.2 +/- 6.2 mm; P < 0.001). Cervical length longer than 35 mm predicted delivery after 34 weeks of gestation with sensitivity and specificity of 88.5% and 88.9%, respectively. The positive and negative predictive values were 96.9% and 66.7%. CONCLUSION: A transvaginal ultrasonographic measurement of the cervix > 35 mm at 18-24 weeks in twin gestation can identify patients at low risk for delivery before 34 weeks. Maternal age, BMI, weights gain, smoking and work during the pregnancy did not influence the duration of the pregnancy.