Preventive health services for young children in Israel: historical development and current challenges.

PURPOSE: Pediatric preventive health services are delivered in many different formats throughout the world. In Israel, these services for young children are provided in designated Maternal Child Health Clinics (MCHC). The history and operation of Israel's MCHC have been described primarily in the Hebrew language medical literature with most of these reports being over a decade old. This paper provides an up to date summary of the evolution and current care in Israel's one-hundred-year old model for the provision of preschool preventive health services. As these clinics have been recognized by the World Organization as a model for emulation, it is important that such information be made available. Israel's MCHC provide universal care to infants and preschool children (0-6 years), free of charge. These community-based clinics provide developmental surveillance, growth monitoring, and routine childhood immunizations. Anticipatory guidance is offered to families on topics including nutrition, parenting and child safety. Screening is also performed for maternal postpartum depression and family violence. Care is given by public health nurses working in collaboration with physicians. The vast majority (> 96%) of the country's children receive care in this system. Immunization coverage rates through this system are in line with World Health Organization guidelines - over 95% overall average nationally. Unfortunately, the allocated funding has not increased in proportion to the population growth. There is ongoing debate on the role of the national government in health services: should it be that of a direct services provider or focus on guidance and regulation of the health system. CONCLUSION: MCHC well child care can help assure widespread provision of pediatric preventive health care. For this model to function, both its funding and content needs to be updated on an ongoing basis to reflect current preventive health care needs.

"Practice What You Teach" Public Health Nurses Promoting Healthy Lifestyles (PHeeL-PHiNe): Program Evaluation.

Healthy lifestyle programs are essential for meeting the challenge of noncommunicable diseases. The Public Health Nurses Promoting Healthy Lifestyles (PHeeL-PHiNe) program engaged nurses from family health clinics in Jerusalem District and included physical activity, healthy nutrition, and motivational skills. Questionnaires were completed at baseline, postintervention, and at 18 months. Results showed a marked effect on health practices. The proportion of nurses consuming a balanced diet and the use of food labels significantly increased and were maintained over time. Short-term improvements in physical activity were also observed. Nurses who practiced a healthy lifestyle were significantly more likely to provide guidance and counseling to families on healthy behaviors.

Public Health Nurses Promoting Healthy Lifestyles (PHeeL-PHiNe): methodology and feasibility.

Mother and Child Health Clinics have provided preventive health services in Israel for nearly a century. The Public Health Nurses Promote Healthy Lifestyles Program was developed to assist families in adopting healthy behaviors. The program ran in the Jerusalem District from 2009 to 2011. After piloting, 175 public health nurses received training and interventions took place in 45 clinics serving parents of 167 213 infant and toddlers per year. When evaluation is completed, our hope is to incorporate the program into Mother and Child Health Clinic services regularly provided nationwide, thereby becoming an integral part of the initiative, Healthy Israel 2020.

Reaching Jewish ultra-orthodox adolescents: results from a targeted smoking prevention trial.

BACKGROUND: Ultra-orthodox, Jewish adolescent boys are considered to have relatively high smoking rates, but are generally not targeted by Israel's smoking prevention programs. OBJECTIVE: The objective of this trial was to test the effectiveness of a religion-based tobacco control intervention in reducing smoking prevalence among these youth. METHODS: The study population participants were 340 boys from 63 religious boys' schools in Jerusalem. The intervention consisted of a mailing that included a pamphlet describing the health effects of and rabbinical prohibitions on smoking. A cluster randomized trial was conducted between March and May, 2005. The primary endpoint was current smoking status. Secondary endpoints were future intent to smoke and attitudes towards smoking. Generalized estimating equations and mixed models of analysis of variance were used to perform the analyses. RESULTS: The intervention did not significantly affect current smoking, intent to smoke or attitudes towards smoking. Prevalence of smoking and future intent to smoke were higher in schools without enforced smoking regulations [odds ratio (OR) 2.74, p=0.026, OR 3.38, p=0.018]. Increased smoking prevalence was associated with a high prevalence of smoking among friends (p=0.031) and not finding smoking repulsive (p=0.024). CONCLUSIONS: This study adds to the public health literature linking smoke-free schools and peer influences to adolescent smoking. Pamphlets containing rabbinic prohibitions on smoking initiation did not affect smoking behavior or intent to smoke.

What do women gain from volunteering? The experience of lay Arab and Jewish women volunteers in the Women for Women's Health programme in Israel.

Ambiguous feelings regarding women engaging in formal volunteering and concerns about their exploitation might explain the dearth of studies regarding the volunteering benefits specifically experienced by low socioeconomic status women. The current study examined benefits of volunteering among women participating in Women for Women's Health (WWH), a lay health volunteers (LHV) programme implemented in Jewish and Arab communities in Israel, and aiming at empowering such women to become active volunteers and promote health activities in their communities. Two years after the introduction of WWH in each community, all 45 Jewish and 25 Arab volunteers were contacted by phone and invited to participate in the focus group discussions. Five focus group discussions were conducted with 25/42 Jewish volunteers in 2003 and four with 20/25 Arab volunteers in 2005. The other volunteers could not attend the scheduled meetings or became inactive for personal reasons. Four benefit categories were identified in both ethnic groups: 1. Personal benefits of having increased knowledge, feeling self-satisfaction, mastering new skills and performing healthy behaviours; 2. Group-social benefits of social support and sense of cohesion; 3. Purposive benefits of achieving the WWH mission and goals; 4. Sociopolitical benefits of learning to accept the other and experiencing increased solidarity. However, the relatively less privileged Arab volunteers enumerated more benefits within the personal and purposive categories. They also identified the unique sociocultural category of improving women's status in the community by creating a legitimate space for women by public sphere involvement, traditionally solely a male domain. We conclude that volunteering in community-based health promotion programmes can be an empowering experience for lay women without being exploitative. Positive volunteering benefits will be even more discernable among underprivileged women who enjoy fewer opportunities in the personal and public domains. More studies need to explore volunteering benefits as reported by LHVs, making these benefits more visible and desirable.