Stress and perceived discrimination among the Arab population in Israel: the mediation role of the perceived COVID-19 threat and trust in the healthcare system.

During pandemics, minorities may experience high stress levels, which could harm their mental and physical health. However, to the best of our knowledge, this has not been examined among minorities in Israel during the COVID-19 pandemic. This study, therefore, explores stress among the Arab minority in Israel during the first wave of the COVID-19 outbreak, and its association with the population's perceived COVID-19 threat, trust in the healthcare system, adherence to preventative guidelines, and perceived discrimination.The study analyzed a cross-sectional online survey of 626 Israeli Arabs. Most participants (65%) reported moderate levels of stress, and 10% reported severe levels. The Bedouin population reported significantly higher levels of stress compared to other minority groups. The participants also reported a high degree of perceived threat, a moderate-to-high level of discrimination, a moderate level of trust in the healthcare system, and very high adherence to guidelines.Hierarchical regression analysis showed that age, religion, trust in the healthcare system, perceived threat, and adherence to guidelines were all significant predictors of stress [F(11,600), p < .001]. The model explained 24% of the variance in stress. Structural equation modeling (SEM) revealed that the participants' perceived threat and trust mediated the association between their perceived discrimination and stress [indirect effect = 0.13, SE = 0.03 CI = (0.08, 0.18)], whereby discrimination was negatively associated with trust (ß = -0.52), which, in turn, was negatively associated with stress (ß = -0.10). Furthermore, discrimination was positively associated with perceived threat (ß = 0.21), which, in turn, was positively associated with stress (ß = 0.35). Discrimination is an important social determinant of health - especially during health emergencies when trust in healthcare systems and perceived threats are crucial. As such, our findings could assist policymakers in developing fair policies that are tailored to various population groups and that may reduce stress levels among minorities, thereby improving both their mental and physical health.

Do Israeli health promoting schools contribute to students' healthy eating and physical activity habits?

The Israeli Health Promoting School Network (HPSN) is actively committed to enhancing a healthy lifestyle for the entire school population. This study aimed to explore the contribution of school participation in the HPSN and students' individual characteristics to healthy eating and physical activity habits among Israeli school children aged 10-12 years. A cross-sectional survey was conducted among 4166 students in grades 4-6 from 28 schools. The schools were selected from a sample of HPSN affiliated and non-HPSN schools. The contribution of individual characteristics (grade, gender and subjective self-reported health education activities at school) and school characteristics (school type, population group, deprivation score) to healthy eating and physical activity habits was analyzed using multi-level hierarchical models. Multi-level analysis indicated that student's individual characteristic was significantly associated with healthy eating and physical activity habits. The subjective self-reported health education received at school was statistically significant factor associated with students' health behaviors. The school's affiliation with the HPSN was not associated with higher healthy eating and physical activity scores after adjusting for individual factors. These findings suggest that Israeli HPSN schools do not contribute to children's health behaviors more than other schools. Therefore, health promoting activities in HPSN schools need to be improved to justify their recognition as members of the HPS network and to fulfill their mission.

The Mediating Role of the Perceived COVID-19 Vaccine Benefits: Examining Israeli Parents' Perceptions Regarding Their Adolescents' Vaccination.

Israel was among the first countries to initiate adolescent COVID-19 vaccination. As adolescent vaccination requires parental consent, we evaluated the factors associated with parents' willingness to vaccinate their adolescents and their point of view regarding adolescents' involvement in this decision. An online survey was completed by 581 parents of adolescents aged 16-18. The main independent variables included trust in the healthcare system, components of the Health Belief Model (HBM) and adolescents' involvement in the decision, as well as background data, including demographics. Analysis included a multiple logistic regression and mediation examination. Parents reported that 446 adolescents (76.8%) have been or will soon be vaccinated against COVID-19, 12.2% chose not to vaccinate their child and 11% have not yet decided. Vaccination was significantly associated with HBM components and with adolescents' involvement in the decision. The perceived vaccination benefits acted as a mediator in the association between parents' COVID-19 perceived threat and adolescent vaccination, as well as between parents' trust in the healthcare system and adolescent vaccination. Addressing vaccination benefits and barriers is pivotal in the attempt to enhance adolescents' vaccination adherence. Considering the importance of adolescents' involvement in the decision, addressing them directly may also be beneficial in improving vaccination rates.

Distancing Adherence and Negative Emotions among the Israeli Elderly Population during the COVID-19 Pandemic.

Social distancing was found to prevent COVID-19 contagion. Therefore, understanding the factors associated with the public's adherence is important. Acknowledging the importance of emotional wellbeing regarding older people's health, and understanding their emotional state during the pandemic, are crucial. This study assessed factors associated with older people's adherence to social distancing and their emotional status. A cross-sectional online survey was conducted among 1822 respondents above the age of 60. Distancing adherence, negative emotion, trust, social support, threat perception, attitudes, and subjective norms were assessed, and a path analysis was performed. Adherence was positively associated with attitudes (ß = 0.10; p < 0.001), and with subjective norms (ß = 0.19; p < 0.001). Negative emotions were positively associated with threat perception (ß = 0.33; p < 0.001), and negatively associated with social support (ß = -0.13; p < 0.001) and subjective norms (ß = -0.10; p < 0.001). Attitudes mediated the relationship of threat perception (95% CI = 0.009, 0.034), trust (95% CI = 0.008, 0.029), and social support (95% CI = 0.006, 0.023) with distancing adherence. Subjective norms mediated the relationship between threat perception (95% CI = 0.014, 0.034), trust (95% CI = 0.026, 0.055), and social support (95% CI = 0.002, 0.048) with distancing adherence. Subjective norms mediated the relationship between threat perception (95% CI = -0.022, -0.006), trust (95% CI = -0.034, -0.010), and social support (95% CI = -0.029, -0.009) with negative emotions. When promoting social distancing adherence, subjective norms and attitudes must be considered, as they play a role in promoting adherence and negative-emotion regulation.

A unique program for nursing students to enhance their mentalization capabilities in relation to clinical thinking.

While nurses strive to provide optimal patient-centered care, this is not always straightforward, as some cases are more emotionally charged than others - depending on the patient's mental, emotional, and physical state, and on the nurses themselves. Therefore, in order to provide accurate therapeutic responses while maintaining their own personal well-being, nurses must develop strong mentalization capabilities. We present a unique program for nursing students, specifically targeted at enhancing their mentalization abilities as part of their communication skills for dealing with emotionally charged situations. In the program, he students first learn to identify what leads them to experience increased emotional loads and how this affects their mentalization processes. Next, they learn alternative coping patterns for their benefit, enabling their own emotional regulation while providing optimal care for their patients. Conducted in small groups, this holistic four-year program is led by experienced clinical nurses and psychologists; the learning is based on actual experiences encountered by the students during their clinical experience.

Implementing the ban on smoking in Israeli pubs: measuring airborne nicotine and enforcement by local authorities.

BACKGROUND: In 2007 an amendment to the law restricting smoking in pubs and bars (P&Bs) was enacted in Israel. However, a year after the ban only slight decreases in airborne smoke in P&Bs in one city have been reported. PURPOSE: We aimed to assess levels of airborne nicotine in Israeli P&Bs and to measure ifself-reported enforcement of the law by local officials was associated with levels of airborne nicotine in P&Bs. METHODS: Airborne nicotine levels were measured in 72 P&Bs in 29 towns in Israel; this consisted of 90% of eligible towns. In addition, 73 local authority officials were interviewed in 25 of these towns. The officials were asked to assess the local authority's level of enforcement of the law banning smoking in P&Bs. The association of levels of airborne nicotine with the levels of enforcement of the law was calculated. Data were collected during 2009-2010 and analyzed in 2010-2011. RESULTS: Levels of airborne nicotine were comparatively high in P&Bs. No association was detected between levels of nicotine and the P&Bs' characteristics. In the larger towns, levels of airborne nicotine were higher. In 16% of towns the local authority officials reported high levels of law enforcement. Generally, levels of reported enforcement by local authorities were low and did not predict levels of airborne nicotine in the P&Bs. CONCLUSIONS: Self-reported local authorities' law enforcement was not associated with levels of airborne nicotine in P&Bs in these towns. There is a need to develop ways to increase law enforcement by the local authorities or other agencies.

Challenges for the smoking ban in Israeli pubs and bars: analysis guided by the behavioral ecological model.

BACKGROUND: The latest amendment to the ban on smoking in public places in Israel was implemented in 2007, adding pubs and bars (P&B) to the list of public places in which smoking is prohibited. However, smoking in most P&B continued. The aim of the study was to identify the theoretically plausible reasons for the partial success of a public ban on smoking in P&B settings. Explanations provided by P&B owners were interpreted as probable causal factors based on the Behavioral Ecological Model (BEM). METHODS: Qualitative interviews were performed with 36 P&B owners in Tel-Aviv and 18 Israeli towns and cities of various population size. RESULTS: P&B owners reported a variety of situational factors (i.e., contingencies) and reinforcers as likely explanations of the partial failure of the legislated ban on smoking in public places, particularly P&B. The major reinforcers for non-adherence with the law were no or low frequency of inspections and low penalties from authorities. P&B owners also feared loss of customers and revenue if bans were enforced in their own establishment but not in competing establishments. Finally, owners reported social norms prevailing among some Israeli patrons supporting smoking in P&B settings, in part to express opposition to the new law. CONCLUSIONS: Qualitative assessment can uncover probable social situations that operate to prevent greater adherence to smoking bans. The results warrant confirmation by quantitative analyses. Policies with mandated inspections and penalty requirements that are implemented in all bars without prejudice could lead to greater adherence to smoking bans. Positive reinforcing consequences that encourage adherence (such as publicity and support from non-smokers) would be more likely to generate both greater adherence to the policy and good will toward the government. Principles of behavior outlined in the BEM offer guidance for designing quantitative confirmation analyses of future bans.