Health and Well-Being Among Those Aging in Place in a Jerusalem Religious Community.

An innovative pilot program in a traditional Jerusalem synagogue was developed to increase medical and social well-being of older community members who want to age in place. The study assessed the impact of the program. Interviews and focus groups were conducted in 2019 with 30 program participants, program staff, and non-program residents and with program leaders a year later. The evaluation found that wellness and healthcare features of a faith-based aging in place program had a generally positive impact, magnified by the group's strong social cohesion. The program's impact and value have increased since COVID-19, with some potential for replication.

A Protective Canopy: Religious and Social Capital as Elements of a Theory of Religion and Health.

In order to help fill the gap in midrange theory for the religion-health connection, this paper reviews relevant literature on religious capital as well as social capital, a concept with which religious capital is sometimes incorrectly conflated. It identifies elements and mechanisms for each type of capital, including both quality and quantity, and describes evidence for their relationship with health. Expanding, unifying, and integrating these theoretical elements can help better understand the underlying mechanisms of the relationship between religion and health, with concomitant policy implications such as faith-based interventions as well as spur additional research on the topic.

The anxiety of not knowing: Diagnosis uncertainty about COVID-19.

The emergence and swift global spread of COVID-19 brought increased anxiety worldwide (Santabárbara et al. (Progress in Neuro-Psychopharmacology & Biological Psychiatry, 109, 110207, 2021)). Research regarding the COVID-19 outbreak addressed factors that contribute to anxiety people experienced as they tried to handle the changes in their lives associated with COVID-19 (Holmes et al. (The Lancet Psychiatry, 7(6), 547-560, 2020)). This paper focuses on diagnosis uncertainty as a particular source of anxiety. We use self-reported anxiety measures to understand how different stressors, and particularly how being sick or being unsure if one or one's close friends or relatives are sick, relate to overall anxiety levels. Five-hundred and thirty-three participants from a country with a stringent COVID-19 testing policy were surveyed in the spring of 2020 on various aspects of their anxiety and risk for depression, as well as on whether they or their friends or family had COVID-19. Analysis of survey results found that anxiety related to uncertainty regarding whether the survey responder or their friends or family were carrying COVID-19 may be even greater than fear of the virus itself. This paper discusses directional issues related to this finding and offers policy implications for decreasing anxiety during pandemics for certain types of communities. In addition to the main findings regarding diagnosis uncertainty and anxiety, this paper's results also indicate the importance of providing participants with an option for "not sure" in closed questions and imply the increased knowledge that can be gained by analyzing an unsure response independently of "yes" or "no".

Community nurses and chronic disease in Israel: Professional dominance as a social justice issue.

Chronic diseases are major causes of health inequalities. Community nurses can potentially make large contributions to chronic illness prevention and management in Israel but may be obstructed by professional dominance of physicians. However, insufficient research exists about community nursing in Israel, and how it may differ from other countries. This study aims to document chronic disease-related community nursing roles in Israel, identify changes and trends in community nursing roles that may increase social justice, and understand how the roles and trends in community health nursing in Israel may differ from developments in other countries. In-depth interviews were performed with 55 Israeli health system professionals, and 692 nurse care-givers were asked open-ended questions. Interview answers were analyzed to find themes and trends. The study found that community nurse roles in Israel have expanded, especially for chronic disease control. Commonalities exist with countries such as the United States and the UK, albeit with important differences. However, continued conflicts with physicians exist, which can limit nurses' contributions to reducing health inequalities. Community nurses' importance is growing. Enabling them to overcome professional dominance and improve chronic disease control can help reduce health inequalities in Israel and elsewhere.

A Jerusalem Synagogue Coping During the Coronavirus Pandemic: Challenges and Opportunities.

A diverse Modern Orthodox synagogue in Jerusalem continued to serve its congregants and maintain community despite closures and restrictions during the coronavirus pandemic. Members were surveyed in April 2020. There were minorities of members who were experiencing mental health issues, especially those less acculturated and no one surveyed received any professional mental health help. About a quarter of the members said that regular check-ins were important but some said they were not receiving enough of them. Synagogues can potentially serve as coping resources for congregants both during periods of crisis as well as during regular periods of operation.

The Inverse U-Shaped Religion-Health Connection Among Israeli Jews.

A growing body of evidence indicates an association between religion and health. However, few have studied the connection between the extent of an individual's religiosity and his health. Analysis of the 2004 Israel National Health Survey was performed. Religiosity was self-identified using five continuous categories, distinctive to Israeli Jews. Bivariate and multivariate analyses examined the relationship between the extent of Religious commitment and several health outcomes. The relationship took the shape of an inverse U function: Israeli Jews in the middle religiously have the worst physical and mental health status on both unadjusted and adjusted bases. Israeli Jews exhibit a non-trivial connection between religiosity and health whereby the most Secular and the most Religious individuals seem to be healthier than individuals in between.

Evaluating community health workers' attributes, roles, and pathways of action in immigrant communities.

Community health workers (CHWs) are uniquely positioned to improve health outcomes in immigrant communities; however, research on appropriate metrics for evaluating CHW attributes and mechanisms of effectiveness are limited. The objective of this paper is to characterize CHW attributes and pathways of action using adapted measures, develop a scale using these measures, and explore how findings can inform future CHW research and practice. The study analyzed pre- and post-intervention group data from one quasi-experimental and three randomized controlled-design parent trials assessing the impact of CHW-led group and individual health coaching on various health outcomes in four New York City immigrant communities. We conducted descriptive, bi-variate and principal components analysis to develop a 13-item scale assessing CHW attributes, roles, and pathways of action. The sample included 437 individuals completing the intervention arm of a CHW study. We found CHWs were reported to affect change through a number of mechanisms and participants expressed substantial communal concordance with the CHWs in terms of country of birth, language, and culture. Principal components analysis with promax rotation identified 13 items with three factors and high Cronbach's alphas: 1) valued interpersonal attributes of the CHW (alpha=0.784); 2) CHW as a bridge to health and non-health resources (alpha=0.857); and 3) providing accessibility beyond health providers (alpha=0.904). Socio-demographic characteristics and differences in CHW pathways of action were identified by community. Study findings can guide improved selection and training of CHWs. Further, measures identified in the principal components analysis can be used to guide future CHW evaluation efforts.

Mental Health and Care Utilization Among Ethiopian-Israeli Immigrants During the Period of COVID-19.

As well as affecting physical health, COVID-19 can impact mental health. Despite this, Israelis may not be getting needed mental health care because of culture-related barriers such as stigma and lack of knowledge about mental health and appropriate care. This is especially likely among vulnerable populations, such as Ethiopian immigrants, yet the topic has been understudied. This study aimed to examine to what extent COVID-19-related mental health stressors and issues are found among Ethiopian-Israelis and the extent of stigma and mental health literacy among Ethiopian-Israelis during the COVID-19 period. It also examined differences between the 1.5th and 2nd generations and potential interventions to improve their mental health. Online surveys were filled out by a convenience sample of 225 Ethiopian-Israelis recruited from a variety of sources in the fall of 2020. Over 40% expressed greater mental distress since COVID-19 started. Stigma and lack of mental health-related knowledge were found among many in this population, serving as potentially important barriers to getting appropriate mental health care. For example, only 52% disagreed with the statement that people with mental illness should not be given any responsibility and only 66% felt confident they could identify having a mental health problem requiring treatment. Variations were found by types of stressors, stigma, and lack of knowledge, as well as by immigration generation, for at least some measures. COVID-19 can negatively impact mental health and appropriate mental health care utilization, especially for a racial/ethnic minority group of immigrants such as Ethiopian-Israelis. Interventions are needed, such as increased education about mental health from a variety of sources, which can help decrease stigma and improve mental health care utilization among this group, especially when appropriately tailored.

Sense of coherence and its components under COVID-19: relative associations with personality and psychosocial variables.

Sense of Coherence (SOC) is conceptualized as promoting resistance to stress. The study aimed to assess the impact of the Big Five personality traits and Social Capital (SC) on SOC levels during COVID-19, comparing associations with the pre-pandemic period. Another aim was to explore how personality and SC relate differently to SOC domains: Comprehensibility, Manageability, and Meaningfulness, reflecting perceptions of order, resource adequacy, and life's significance, respectively. SOC, Big Five personality traits, SC (using by the 13 items SOC scale, NEO-FFI and PSCS inventories, respectively) and demographic data were obtained from 2717 Israeli participants during the heights of the third COVID-19 wave (November 2020-March 2021). Strong relationships between SOC and personality traits have been found through regression analysis, but these associations differed between SOC domains. Big Five traits demonstrated comparable association with Comprehensibly and Manageability, but different from those with Meaningfulness, particularly in Neuroticism, Openness and Extraversion. Significant SC-SOC associations were observed, though weaker than those reported in the pre-pandemic period. Age and female sex were also associated with stronger SOC. Overall, effect sizes for SOC domains were medium to large for Big Five personality traits and small to medium for demographic variables. SC demonstrated a negligible effect size. Significant interactions of demographic, SC and personality traits were also observed. The study highlights SOC's strong links with personality and demographics, but weaker ties with psychosocial factors. Variations across SOC domains may explain diverse crisis effects.

The economic impact of a patient navigator program to increase screening colonoscopy.

BACKGROUND: Patient navigation can increase colorectal cancer screening rates. The net economic impact of a colonoscopy patient navigator program was evaluated in an urban public hospital setting. METHODS: Cost, cost-effectiveness, and cost-benefit analyses were performed of a colonoscopy patient navigation program at 3 urban public hospitals in the period from 2003 to 2007. Program effectiveness was assessed in a 2-group, pre- and post-program, nonrandomized evaluation, comparing program hospitals with comparison hospitals that served similar populations. Costs were assessed from the provider's perspective. Outcomes included colonoscopy volume, colonoscopy completion rate, program cost, incremental cost-effectiveness, and net monetary benefit. RESULTS: Patient navigation was associated with a 61% increase in average monthly colonoscopy volume at program hospitals, from 114 procedures to 184 procedures, compared with a 12% increase at comparison hospitals. Adjusted for other factors, the navigator program increased colonoscopy volume by 44 to 67 additional procedures per month. Average program cost varied from $50 to $300 per patient referred to a navigator. Incremental cost-effectiveness varied from $200 to $700 per additional colonoscopy. At 2 hospitals, net revenue associated with increased colonoscopy volume exceeded the program cost per additional colonoscopy, yielding a net financial benefit; at the third hospital, the program yielded a net cost. Variation between hospitals in the program's economic impact was primarily attributable to differences in personnel costs. CONCLUSIONS: Economic evaluation of this colonoscopy patient navigator program in an urban public hospital setting suggests that such programs can be a cost-effective use of limited resources and yield a net financial benefit for providers.

Barriers to Colorectal Cancer Screening Among Russian-speaking Immigrants: The Importance of Culture and Home Country Experiences.

There is potential to improve low colorectal cancer screening rates, reduce mortality, and narrow health disparities, if the distinctive screening barriers among Russian-speaking immigrants were better understood. However, there is little relevant research about the topic. To address this gap, this study aimed to identify barriers to timely colorectal cancer screening, especially colonoscopies, among Russian-speakers in New York City. Thirteen key informant interviews were performed with providers, community leaders, and academics. Eight focus groups were then conducted with 81 Russian-speaking individuals, age 50-75, who had not had a timely colonoscopy. Results were translated, transcribed, coded and analyzed. Barriers identified included individual, communal, and structural issues. Distinctive barriers, such as those related to culture and to the experiences of living under the Soviet system, were uncovered. Barriers identified can potentially be reduced through interventions suggested by the research, including more education and more effective provider recommendations.

Role of Participation in Activities and Perceived Accessibility on Quality of Life among Nondisabled Older Adults and Those with Disabilities in Israel during COVID-19.

During the COVID-19 pandemic, quality of life (QoL) was reduced among many groups, including Israeli older adults. This study investigated perceived QoL, perceived accessibility of the living environment, and participation in activities among nondisabled older adults and those with disabilities in the community. It also examined whether the perceived accessibility's effect on QoL occurs directly and/or indirectly via mediators of participation in community activities. A voluntary and anonymous survey was administered from February to May 2021 to 495 participants aged 60 and older. Respondents completed three questionnaires: WHOQOL-BREF, Community Integration Questionnaire-Revised (CIQ-R), and Perceived Accessibility of Living Environment (PALE). The main finding was that participation in activities in the community had a direct positive impact on QoL. Perceived accessibility of the living environment also had indirect positive effects on QoL through participation in activities in the community, for those without disabilities but, interestingly, not for those with disabilities. Hierarchal linear regressions revealed that participation in activities explained 53.3% of the variance for both groups while perceived accessibility added 1.1% for the nondisabled. We conclude that accessibility of living environment is a good indicator of positively perceived QoL through participation in various activities in the community for nondisabled older adults. This may be especially important during a pandemic.

Promoting a Culturally Adapted Policy to Deal with the COVID-19 Crisis in the Haredi Population in Israel.

COVID-19 has caused high morbidity and mortality in Israel but, as in other countries, not all groups were equally affected. Haredi Jews (often called ultra-Orthodox), a religious minority, were disproportionately harmed by the pandemic. This group has distinctive cultural, lifestyle, and demographic characteristics, which may be related to these higher COVID-19 rates and call for policies specifically adapted for this community. This paper describes in detail the steps the Israeli Ministry of Health (MoH) took to try to improve the quality of care and prevent morbidity in the Haredi population through working in cooperation with the leadership and members of the Haredi community and strengthening mutual trust in order to increase adherence to government regulations and recommendations. This case study is based on the unique perspective of the two people who worked in the Israeli MoH and led the initiative as well as a review of relevant government documents and statistics. It discusses to what extent the initiative seemed to have been successful and what lessons can be learned not only for Haredim but for other religious and/or minority groups and closed communities in Israel and elsewhere.

Predictors of respiratory cancer-related mortality for Jews and Arabs in Israel.

BACKGROUND: Respiratory cancers, including lung, tracheal and bronchus cancers, are a leading cause of cancer-related mortality in Israel; however, incidence can differ among demographic groups. Despite the importance of sociodemographic characteristics and the interactions between them to incidence and mortality, this topic is understudied. This study analyzes sociodemographic disparities by sex and ethnicity among Jews and Arabs to understand cancer outcome differences stratified by SES, marital status, and number of children as potential contextual factors. METHODS: This retrospective cohort study analyzed respiratory cancer-related mortality rates among Israelis born between 1940 and 1960 over 21-years. The follow up period was between January 1, 1996 and 12.31.2016. Mortality rates for Jews and Arabs were calculated. Using a Cox Regression, a multivariate model was constructed to determine the association between ethnicity and respiratory cancer mortality. The study population was then divided into four groups, by sex and ethnicity, to determine the association between marital status, number of children, and SES with respiratory cancer mortality for each subgroup. RESULTS: The overall mortality rate was 0.6%. Arabs had higher mortality rates compared to Jews, even after adjusting for demographic factors including age, sex and SES (Adjusted Hazard Ratio (AHR) = 1.442, 99% confidence intervals (CI) = 1.354,1.546). Among men, a higher mortality rate was found among Arabs (AHR = 1.383, 99%CI = 1.295,1.477), while among women, Arabs had lower mortality rates (AHR = 0.469, 99%CI = 0.398,0.552). Significant mortality rate differences were observed by ethnicity and sex for each sociodemographic variable. CONCLUSIONS: This study highlights the importance and implications of understanding differences in respiratory cancer mortality between Jews and Arabs, a minority group in Israel, and is relevant for minority groups in general. There is a need to tailor interventions for these groups, based on differing underlying causes and contextual factors for these cancers. Cancer outcomes among these groups should also be studied separately, by sex, to better understand them.

Mental health stressors in Israel during the coronavirus pandemic.

A survey of 503 Israelis, performed in April 2020, found high levels of anxiety and risk for depression; these mental health issues were associated with several stressors connected with the coronavirus and related policies. However, only a small percentage of the sample received mental health care from a professional, with native-born Israelis less likely than recent immigrants to receive such care. Some possible initiatives based on these findings are suggested. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Ethnic Disparities in Physical Activity among Adolescents in Israel.

Objectives: In this study, we examined physical activity (PA) levels among Jewish and Arab adolescents in Israel, as well as factors associated with PA. We used a socio-ecological framework to understand differences in levels of PA across ethnic groups and the factors associated with these differences. Methods: We used data based on the Israeli population as reported in the 2014-15 Health Behavior of School-Aged Children standardized survey, which studied 16,145 Israeli adolescents. Levels of PA, as well as parent, sibling, and peer engagement in PA, in-school PA breaks, and liking PA were measured across ethnic groups and sex. Results: Jewish adolescents reported higher levels of PA. Girls were significantly less physically active than boys in both ethnicities. In addition, we found that family, peer, and school related factors were positively associated with levels of PA. Conclusions: Our findings show a disparity in PA levels by ethnicity among Israel adolescents, which can lead to health disparities. We propose targeted interventions involving the factors affecting PA to reduce health disparities.

Places of Habits and Hearts: Church Attendance and Latino Immigrant Health Behaviors in the United States.

INTRODUCTION: In general, church attendance can be associated with improved health behaviors and fewer related chronic diseases, suggesting a potential opportunity to counteract worsening health behaviors among some immigrants and thereby reduce health disparities. There is a paucity of research, however, on the relationship between religious involvement and immigrants' health behaviors and whether it varies by host or home country context. AIM: To examine the relationship between religious involvement, measured by church attendance, with health behaviors among Latino immigrants in the United States (U.S.) and to compare the relationship of home and host country attendance with these behaviors. METHODS: Data from the randomized New Immigrant Survey, including over 1200 immigrants to the U.S. from Mexico and Central America, were analyzed. Health measures included smoking, binge drinking, physical activity, and obesity. Descriptive and multivariate logistic regression analyses were performed using measures of church attendance and ethnic/immigrant characteristics as well as other demographic and health care factors. Separate models were constructed for each behavior. RESULTS: An association was found between U.S. church attendance and less smoking, less drinking, and greater physical activity but not with obesity. Threshold effects were found. However, almost no associations were found between health behaviors and home country church attendance. CONCLUSION: The context in which people live warrants increased attention for successful health promotion initiatives for immigrant populations. The social, psychological, and religious resources in immigrant communities can be leveraged to potentially counteract worsening of chronic disease-related health behaviors of Latino immigrants in the U.S., thereby reducing health disparities.

Health care access and satisfaction in Judean and Samarian communities: opportunities for improving care.

BACKGROUND: There are distinctive potential barriers to optimal health care in Judea and Samaria because of access and satisfaction levels, including obstacles such as its isolation and health care capacity. However, there is a lack of research focusing on health care for the Jewish communities in this region, often referred to as the West Bank. RESEARCH QUESTIONS: What is the level of health care access and satisfaction for Israelis living in the Jewish communities in Judea and Samaria? How do these results compare to parallel results for Israelis in general? How do these results vary by subgroups, in particular by location? METHODS: Two hundred fourty six residents of Judea and Samaria in six diverse, Jewish communities were surveyed, with a 76% response rate. Descriptive analyses were performed for all variables. Bivariate analyses for access and satisfaction measures were performed by key demographic variables. Comparisons were also made with Israelis in general (the vast majority of whom do not live in Judea or Samaria), by comparing our survey results to the results of 2016 Myers-JDC-Brookdale Institute national satisfaction survey. Our survey questions were based on this national survey, tested and used for several cohorts. RESULTS: Of those surveyed, 14% decided to forego treatment because of the distance, although only 3% declined treatment because of cost. There was a diversity of results in terms of satisfaction measures, although in no categories were even half of respondents very satisfied; results ranged from 7% very satisfied with health care system overall to 47% very satisfied with their family physician's attitude. Variations were found by community with local council communities generally, but not always, having the highest satisfaction. Compared to Israelis in general, Israeli residents of Judea and Samaria reported generally lower satisfaction, including 9% fewer being very satisfied with the health plan overall and 10% fewer being very satisfied with referrals. However, 7% more had confidence in getting the best treatment. CONCLUSIONS: Access to care involves more than just coverage. Health care system problems among Israelis living in Judea and Samaria include not just quantity, but quality of services offered. There is a need for improvement not only in health care resources, but also in the level of access and satisfaction in this region.

Patient satisfaction with different interpreting methods: a randomized controlled trial.

BACKGROUND: Growth of the foreign-born population in the U.S. has led to increasing numbers of limited-English-proficient (LEP) patients. Innovative medical interpreting strategies, including remote simultaneous medical interpreting (RSMI), have arisen to address the language barrier. This study evaluates the impact of interpreting method on patient satisfaction. METHODS: 1,276 English-, Spanish-, Mandarin-, and Cantonese-speaking patients attending the primary care clinic and emergency department of a large New York City municipal hospital were screened for enrollment in a randomized controlled trial. Language-discordant patients were randomized to RSMI or usual and customary (U&C) interpreting. Patients with language-concordant providers received usual care. Demographic and patient satisfaction questionnaires were administered to all participants. RESULTS: 541 patients were language-concordant with their providers and not randomized; 371 were randomized to RSMI, 167 of whom were exposed to RSMI; and 364 were randomized to U&C, 198 of whom were exposed to U&C. Patients randomized to RSMI were more likely than those with U&C to think doctors treated them with respect (RSMI 71%, U&C 64%, p < 0.05), but they did not differ in other measures of physician communication/care. In a linear regression analysis, exposure to RSMI was significantly associated with an increase in overall satisfaction with physician communication/care (beta 0.10, 95% CI 0.02-0.18, scale 0-1.0). Patients randomized to RSMI were more likely to think the interpreting method protected their privacy (RSMI 51%, U&C 38%, p < 0.05). Patients randomized to either arm of interpretation reported less comprehension and satisfaction than patients in language-concordant encounters. CONCLUSIONS: While not a substitute for language-concordant providers, RSMI can improve patient satisfaction and privacy among LEP patients. Implementing RSMI should be considered an important component of a multipronged approach to addressing language barriers in health care.