The drinking of earlier and more recent Russian immigrants to Israel: comparison to other Israelis

Triangulation of evidence on immigration and rates of alcohol use disorder in Sweden: Evidence of acculturation effects

BACKGROUND

This study aimed to determine the robustness of the impact of immigration on risk for alcohol use disorder (AUD) using different measures, designs, and immigrant regional cohorts.

METHODS

The analytic sample included all individuals born between 1950 and 1990 and registered in Sweden from 1973 to 2017. Using Cox regression models, we examined the risk for AUD from Swedish nationwide registries in immigrants to Sweden from seven geographical regions: Africa, Asia and Oceania, Eastern Europe, Finland, Latin America and the Caribbean, Middle East/North Africa, and Western countries. We assessed greater exposure to Swedish culture, which we interpreted as increasing acculturation, by (i) comparing first-generation immigrants and their children with no and one native Swedish parent and (ii) examining age at immigration. The baseline comparison group was the native Swedish population. We also examined AUD risk in first-generation sibling pairs discordant for their age at immigration.

RESULTS

In nearly all immigrant cohorts in Sweden, increasing degrees of acculturation, as assessed by both our variables, were associated with rates of AUD that approached those of the Swedish population. These findings occurred in both men and women and both regional cohorts whose first-generation immigrants had lower and higher levels of AUD than native-born Swedes. For most cohorts, the rates of change with acculturation were greater in women than in men. In sibling pairs from most regions, the sibling who was younger at immigration had a higher rate of AUD.

CONCLUSIONS

An examination of both sexes and two different proxies for acculturation provides consistent support for socio-cultural influences on AUD risk. Our co-sibling analyses suggest that a meaningful proportion of this effect is likely to be causal in nature.

Social Capital as a Moderator of the Relationship Between Perceived Discrimination and Alcohol and Cannabis Use Among Immigrant and Non-immigrant Adolescents in Israel

Literature highlights the relationship between perceived discrimination and frequency and severity of alcohol and cannabis use. One mechanism for explaining this is the nature of perceived discrimination as a potentially traumatic interpersonal stressor, which can lead to the depletion of social and personal resources. Within a Recovery Capital (RC) framework, the current study explores whether the existence of social capital in the form of parental monitoring, friend and teacher support can buffer the relationship between perceived discrimination and alcohol and cannabis use among immigrant and non-immigrant adolescents, by replenishing the depleted resources. The study included a representative sample of 8,598 students in Israel, aged 11-18, from the Health Behaviors of School Aged Children (HBSC) 2013-2014 data: 1503 immigrant adolescents from the Former Soviet Union [FSU] (N = 955) and Ethiopia (N = 548) and 7086 non-immigrants. Results confirmed that perceived discrimination was positively related to substance use; all three forms of social capital were negatively related to alcohol and cannabis use and moderated the relationship between perceived discrimination and substance use, with the exception of friend support in the case of alcohol use. When all three social capital measures were included together, the adult social capital measures were significant predictors of substance use. Results suggest that levels of social capital, especially as provided by parents and teachers, can help young people, both immigrant and majority group adolescents, to cope with perceived discrimination.

Unmet need for treatment of depression among immigrants from the former USSR in the US: A primary care study

The stress of immigration can increase risk for major depressive disorder (MDD), while cultural factors can contribute to difficulty in diagnosis and treatment of MDD among immigrant populations. Consequently, immigrants are less likely to have their treatment needs met. Our goal was to assess the unmet need for the diagnosis and treatment of depression among immigrants from the former USSR-a large immigrant group in the US-as well as demographic characteristics and immigration history associated with depression. We conducted a survey in an urban primary care clinic using measures of MDD symptoms (Patient Health Questionnaire-9), functioning, and treatment history among 102 Russian-speaking immigrants. Current moderate-to-severe symptoms of MDD were reported by 26.5% of participants with 33.3% of the symptomatic patients reporting suicidal ideation. Among participants with probable MDD, 63.0% reported not receiving mental health treatment and 59.3% never being diagnosed with MDD. The rates of untreated depression did not vary by gender nor did they diminish with prolonged stay in the US. Results suggest that undiagnosed and untreated depression is highly prevalent in this immigrant group.

Parental alcohol history differentially predicts offspring disorders in distinct subgroups in Israel

OBJECTIVE

The association between alcoholism in parents and related disorders in their offspring is well established in cultures with intermediate/high alcohol consumption, but not in those with low consumption, such as Israel. This study investigated differences in parental transmission of alcohol problems and related psychopathology between immigrants from the former Soviet Union (FSU) to Israel and other Israelis-two Israeli subgroups with differing alcohol consumption behaviors and social norms.

METHOD

A total of 1,347 adults from a household sample were interviewed. Regression analyses were used to examine associations between parental alcohol problems and participant disorders: alcohol, nicotine, and cannabis use disorders (AUD, NUD, CUD); antisocial personality disorder (ASPD); major depressive disorder (MDD); and posttraumatic stress disorder (PTSD). We also examined the associations of parental alcohol problems with participant disorders characterized with two latent factors: externalizing (EXT: AUD, NUD, CUD, ASPD) and internalizing (INT: MDD, PTSD). Differential parental transmission of alcohol problems in FSU (n = 315) and non-FSU (n = 1,032) Israelis was examined with statistical interaction.

RESULTS

Among emigrants from the FSU, parental alcohol problems predicted AUD, NUD, CUD, ASPD, PTSD, EXT, and INT (mean ratios = 1.38-4.83). In non-FSU Israelis, parental alcohol problems predicted only ASPD and PTSD (mean ratios = 1.08-4.09). Significant interactions were observed for AUD, CUD, PTSD, and EXT; each relationship was stronger in FSU Israelis and null (AUD, CUD, EXT) or less robust (PTSD) in other Israelis.

CONCLUSIONS

Parental alcohol problems were related to substance use and psychiatric disorders differently in FSU and other Israelis, two groups with different alcohol consumption levels and drinking norms. We propose that, in social contexts that vary in the degree to which they constrain alcohol behavior, underlying genetic predispositions may manifest as different disorders.

Discrimination and Ethnic Identity as Predictors of Substance Use and Delinquency Among Immigrant Adolescents From the FSU and Ethiopia in Israel

The current study explores perceived discrimination and ethnic identity as predictors of delinquency and substance use among adolescent immigrants in Israel. Theoretically, the study draws from strain theory, immigration-related theories of ethnic identity formation in adolescence, bi-dimensional theories of acculturation, and the rejection-identification model. The study involved 250 adolescents, 140 from the Former Soviet Union (FSU) and 110 from Ethiopia, aged 15 to 18 years ( M = 16.7 years). Adolescents were assessed on substance use (cigarettes, marijuana, binge drinking, drunkenness), delinquent behavior, parental relationships (support, limit setting), perceived discrimination, host identity (Jewish Israeli), and ethnic identity (Russian/Ethiopian). Results from structural equation modeling showed that delinquency was predicted directly by greater discrimination, a weaker ethnic (Russian/Ethiopian) identity, and greater substance (alcohol and cigarette) use. Higher levels of parental limit setting and lower levels of parental support predicted higher levels of substance use, but only predicted delinquency indirectly through their impact on substance use. Findings support the hypotheses that perceived discrimination and a weaker ethnic identity predict involvement in delinquency and partially support a hypothesis that higher levels of a positive host identity are related to lower levels of substance use and delinquency among immigrant adolescents. A perceived lack of equal opportunities may lead to stress, anger, and frustration toward society leading to delinquent behavior, whereas difficulties in consolidating a positive cultural identity may lead the young adolescent to fill a void through substance use.

Childhood adversity moderates the effect of ADH1B on risk for alcohol-related phenotypes in Jewish Israeli drinkers

Childhood adversity and genetic variant ADH1B-rs1229984 have each been shown to influence heavy alcohol consumption and disorders. However, little is known about how these factors jointly influence these outcomes. We assessed the main and additive interactive effects of childhood adversity (abuse, neglect and parental divorce) and the ADH1B-rs1229984 on the quantitative phenotypes 'maximum drinks in a day' (Maxdrinks) and DSM-Alcohol Use Disorder (AUD) severity, adjusting for demographic variables, in an Israeli sample of adult household residents (n = 1143) evaluated between 2007 and 2009. Childhood adversity and absence of the protective ADH1B-rs1229984 A allele were associated with greater mean Maxdrinks (mean differences: 1.50; 1.13, respectively) and AUD severity (mean ratios: 0.71; 0.27, respectively). In addition, childhood adversity moderated the ADH1B-rs1229984 effect on Maxdrinks (P < 0.01) and AUD severity (P < 0.05), in that there was a stronger effect of ADH1B-rs1229984 genotype on Maxdrinks and AUD severity among those who had experienced childhood adversity compared with those who had not. ADH1B-rs1229984 impacts alcohol metabolism. Therefore, among those at risk for greater consumption, e.g. those who experienced childhood adversity, ADH1B-rs1229984 appears to have a stronger effect on alcohol consumption and consequently on risk for AUD symptom severity. Evidence for the interaction of genetic vulnerability and early life adversity on alcohol-related phenotypes provides further insight into the complex relationships between genetic and environmental risk factors.

Parental psychopathology moderates the influence of parental divorce on lifetime alcohol use disorders among Israeli adults

BACKGROUND

Parental divorce and psychopathology are well-documented risk factors for alcohol use disorders (AUD) in the United States and other countries where divorce is common and per capita total alcohol consumption is moderate to high. However, little is known about these relationships in countries where divorce and alcohol problems are less common, such as Israel.

METHODS

Israeli adult household residents (N=797) age 21-45 were interviewed in person between 2007 and 2009. Logistic regression models were used to examine main and additive interaction effects of parental divorce and psychopathology on lifetime DSM-IV AUD, adjusting for age, gender, and ethnicity.

RESULTS

Parental divorce (OR=2.18, p≤0.001) and parental psychopathology (OR=1.61, p≤0.01) were independently associated with lifetime AUD and, when considered together, showed significant interaction (p=0.026). Specifically, the effect of divorce on AUD was only significant among those who also reported parental psychopathology.

CONCLUSIONS

This is the first study showing the influence of parental divorce and psychopathology on risk for AUD among Israeli adults, where both divorce and AUD are less common than in the United States. Alcohol prevention and treatment professionals should recognize that children who experience parental divorce and/or psychopathology could be more vulnerable to later developing AUD than those whose parents remain together and without psychopathology.

Parental, peer and school experiences as predictors of alcohol drinking among first and second generation immigrant adolescents in Israel

BACKGROUND

Ecological perspectives stress the importance of environmental predictors of adolescent alcohol use, yet little research has examined such predictors among immigrant adolescents. This study examines parental, peer and school predictors of alcohol drinking (casual drinking, binge drinking and drunkenness) among Israeli-born adolescents and first and second generation adolescent immigrants from the Former Soviet Union (FSU) and Ethiopia in Israel.

METHODS

The study uses data from the 2010 to 2011 Israeli Health Behaviors of School age Children (HBSC) survey and includes a representative sample of 3059 adolescents, aged 11-17. Differences between the groups for drinking were examined using Pearson's chi square. Logistic regression models were used to examine group specific predictors of drinking.

RESULTS

First generation FSU and both Ethiopian groups reported higher levels of binge drinking and drunkenness than Israeli-born adolescents. All immigrant groups reported lower levels of parental monitoring than native born adolescents; both first generation groups reported difficulties talking to parents; and first generation FSU and second generation Ethiopian adolescents reported greater time with friends. Group specific logistic regression models suggest that while parent, peer and school variables all predicted alcohol use among Israeli adolescents, only time spent with peers consistently predicted immigrant alcohol use.

CONCLUSIONS

Findings highlight specific vulnerability of first generation FSU and second generation Ethiopian adolescents to high levels of drinking and the salience of time spent with peers as predicting immigrant adolescent drinking patterns. They suggest that drinking patterns must be understood in relation to country of origin and immigration experience of a particular group.

Trauma exposure, posttraumatic stress disorder and risk for alcohol, nicotine, and marijuana dependence in Israel

BACKGROUND

Substance dependence is more common among trauma-exposed individuals; however, most studies suggest that Posttraumatic Stress Disorder (PTSD) accounts for the link between trauma exposure (TE) and substance dependence.

OBJECTIVES

This study examined associations between TE and substance dependence (alcohol, nicotine, and marijuana), and whether PTSD accounted for this association.

METHOD

1317 Jewish Israeli household residents completed in-person structured interviews assessing TE, PTSD, and substance (alcohol, nicotine, marijuana) dependence between 2007 and 2009. Regression analyses examined associations among TE, PTSD, and substance dependence.

RESULTS

In the full sample, mean number of traumatic events was 2.7 (sd=2.2), with 83.7% experiencing at least one event. In the full sample, mean number of PTSD symptoms was 2.5 (sd=3.4), with 13.5% meeting PTSD diagnostic criteria. Prevalence of alcohol dependence was 13.4%; nicotine dependence 52.8%; and marijuana dependence 12.1%. Number of traumatic events was associated with increased odds of alcohol (OR=1.3; 95% CI=1.2-1.4) and nicotine (OR=1.2; 95% CI=1.1-1.3) dependence. Similarly, any traumatic event exposure was associated with increased odds of alcohol (OR=3.1; 95% CI=1.6-6.0) and nicotine (OR=1.9; 95% CI=1.2-2.9) dependence. PTSD symptoms were associated with increased odds of alcohol (OR=1.2; 95% CI=1.1-1.3), nicotine (OR=1.1; 95% CI=1.1-1.2), and marijuana (OR=1.1; 95% CI=1.04-1.2) dependence; similarly, a PTSD diagnosis was associated with increased odds of alcohol (OR=3.4; 95% CI=2.1-5.5), nicotine (OR=2.2; 95% CI=1.4-3.4), and marijuana (OR=2.6; 95% CI=1.2-5.9) dependence. PTSD symptoms accounted for a sizeable proportion of the TE effect on alcohol (46%) and nicotine dependence (31%).

CONCLUSION

Individuals with more traumatic events had heightened risk for alcohol and nicotine dependence, and PTSD symptoms partially accounted for this risk. However, marijuana dependence was only significantly related to PTSD symptoms. Clinicians and researchers should separately assess different types of dependence among trauma-exposed individuals both with and without PTSD symptoms.

Alcohol dependence and suicide-related ideation/behaviors in an Israeli household sample, with and without major depression

BACKGROUND

Suicide-related ideation and behaviors (SRIB) are associated with both alcohol disorders and major depressive disorder (MDD). The objective of this study was to evaluate the relationship of alcohol dependence (AD) and major depression to the risk for lifetime SRIB.

METHODS

Data from a community-based sample of 1,237 adult Israeli lifetime drinkers assessed with reliable diagnostic measures were analyzed using logistic regression.

RESULTS

Lifetime SRIB was reported in 4.7% and was more prevalent among participants with AD (9.0%) than among those without AD (4.1%); p-value = 0.01. Although both AD and major depression were associated with SRIB (AD: OR 2.2, 95% CI 1.1 to 4.4; MDD: OR 11.4, 95% CI = 6.4 to 20.4), joint analysis showed that AD without MDD increased risk for SRIB as compared to those without AD or MDD (OR 3.1, 95% CI 1.1 to 9.1), but AD did not increase risk among those with MDD (OR 1.1, 95% CI 0.4 to 2.7). Among those with AD, the severity of subclinical depressive symptoms was associated with increased SRIB.

CONCLUSIONS

These findings show that AD increases risk for SRIB among individuals without a history of major depression. Suicidal tendencies may be undetected and underdiagnosed in this group because of the absence of major depression and therefore left untreated. These findings should be considered when adopting suicide prevention or treatment strategies for this high-risk subpopulation.

Validity of proposed DSM-5 diagnostic criteria for nicotine use disorder: results from 734 Israeli lifetime smokers

BACKGROUND

The fifth edition of the diagnostic and statistical manual of mental disorders (DSM-5) proposes aligning nicotine use disorder (NUD) criteria with those for other substances, by including the current DSM fourth edition (DSM-IV) nicotine dependence (ND) criteria, three abuse criteria (neglect roles, hazardous use, interpersonal problems) and craving. Although NUD criteria indicate one latent trait, evidence is lacking on: (1) validity of each criterion ; (2) validity of the criteria as a set ; (3) comparative validity between DSM-5 NUD and DSM-IV ND criterion sets ; and (4) NUD prevalence.

METHOD

Nicotine criteria (DSM-IV ND, abuse and craving) and external validators (e.g., smoking soon after awakening, number of cigarettes per day) were assessed with a structured interview in 734 lifetime smokers from an Israeli household sample. Regression analysis evaluated the association between validators and each criterion. Receiver operating characteristic analysis assessed the association of the validators with the DSM-5 NUD set (number of criteria endorsed) and tested whether DSM-5 or DSM-IV provided the most discriminating criterion set. Changes in prevalence were examined.

RESULTS

Each DSM-5 NUD criterion was significantly associated with the validators, with strength of associations similar across the criteria. As a set, DSM-5 criteria were significantly associated with the validators, were significantly more discriminating than DSM-IV ND criteria, and led to increased prevalence of binary NUD (two or more criteria) over ND.

CONCLUSIONS

All findings address previous concerns about the DSM-IV nicotine diagnosis and its criteria and support the proposed changes for DSM-5 NUD, which should result in improved diagnosis of nicotine disorders.

Alcohol-metabolizing genes and alcohol phenotypes in an Israeli household sample

BACKGROUND

Alcohol dehydrogenase 1B and 1C (ADH1B and ADH1C) variants have been robustly associated with alcohol phenotypes in East Asian populations, but less so in non-Asian populations where prevalence of the most protective ADH1B allele is low (generally <5%). Further, the joint effects of ADH1B and ADH1C on alcohol phenotypes have been unclear. Therefore, we tested the independent and joint effects of ADH1B and ADH1C on alcohol phenotypes in an Israeli sample, with higher prevalence of the most protective ADH1B allele than other non-Asian populations.

METHODS

A structured interview assessed lifetime drinking and alcohol use disorders (AUDs) in adult Israeli household residents. Four single nucleotide polymorphisms (SNPs) were genotyped: ADH1B (rs1229984, rs1229982, and rs1159918) and ADH1C (rs698). Regression analysis examined the association between alcohol phenotypes and each SNP (absence vs. presence of the protective allele) as well as rs698/rs1229984 diplotypes (also indicating absence or presence of protective alleles) in lifetime drinkers (n = 1,129).

RESULTS

Lack of the ADH1B rs1229984 protective allele was significantly associated with consumption- and AUD-related phenotypes (OR = 1.77 for AUD; OR = 1.83 for risk drinking), while lack of the ADH1C rs698 protective allele was significantly associated with AUD-related phenotypes (OR = 2.32 for AUD). Diplotype analysis indicated that jointly ADH1B and ADH1C significantly influenced AUD-related phenotypes. For example, among those without protective alleles for ADH1B or ADH1C, OR for AUD was 1.87 as compared to those without the protective allele for ADH1B only and was 3.16 as compared to those with protective alleles for both ADH1B and ADH1C.

CONCLUSIONS

This study adds support for the relationship of ADH1B and ADH1C and alcohol phenotypes in non-Asians. Further, these findings help clarify the mixed results from previous studies by showing that ADH1B and ADH1C jointly effect AUDs, but not consumption. Studies of the association between alcohol phenotypes and either ADH1B or ADH1C alone may employ an oversimplified model, masking relevant information.

Alcohol use disorders and perceived drinking norms: ethnic differences in Israeli adults

OBJECTIVE

Individuals' perceptions of drinking acceptability in their society (perceived injunctive drinking norms) are widely assumed to explain ethnic group differences in drinking and alcohol use disorders (AUDs), but this has never been formally tested. Immigrants to Israel from the former Soviet Union (FSU) are more likely to drink and report AUD symptoms than other Israelis. We tested perceived drinking norms as a mediator of differences between FSU immigrants and other Israelis in drinking and AUDs.

METHOD

Adult household residents (N = 1,349) selected from the Israeli population register were assessed with a structured interview measuring drinking, AUD symptoms, and perceived drinking norms. Regression analyses were used to produce odds ratios (OR) and risk ratios (RR) and 95% confidence intervals (CI) to test differences between FSU immigrants and other Israelis on binary and graded outcomes. Mediation of FSU effects by perceived drinking norms was tested with bootstrapping procedures.

RESULTS

FSU immigrants were more likely than other Israelis to be current drinkers (OR = 2.39, CI [1.61, 3.55]), have higher maximum number of drinks per day (RR = 1.88, CI [1.64, 2.16]), have any AUD (OR = 1.75, CI [1.16, 2.64]), score higher on a continuous measure of AUD (RR = 1.44, CI [1.12, 1.84]), and perceive more permissive drinking norms (p < .0001). For all four drinking variables, the FSU group effect was at least partially mediated by perceived drinking norms.

CONCLUSIONS

This is the first demonstration that drinking norms mediate ethnic differences in AUDs. This work contributes to understanding ethnic group differences in drinking and AUDs, potentially informing etiologic research and public policy aimed at reducing alcohol-related harm.

Suicidal behavior among immigrants

INTRODUCTION

This paper explores the association between suicidal behavior and immigrant status among Israeli residents from the former USSR (FSU).

METHOD

The Israeli component of the World Mental Health Survey (INHS) provided information on suicide ideations, plans and attempts. The INHS samples included Israel-born Jews (n = 2,114) and post-1990 immigrants from the FSU (n = 814). Data on completed suicide were extracted from the countrywide report of the Ministry of Health.

RESULTS

The controlled lifetime rates of suicidal behavior among FSU immigrants were significantly higher than among their Israel-born counterparts. A higher risk was found in the first years following immigration among young adults with higher education and without a spouse. Completed suicide rates were higher among the FSU immigrants than in the general Israeli population with the largest risk among young-adult immigrant men.

DISCUSSION

The findings are consistent with previous studies and are discussed in the context of both suicide rates in the country of origin and migratory stressors. Preventive measures are suggested.

Nicotine dependence, abuse and craving: dimensionality in an Israeli sample

AIMS

Evidence-based changes planned for Diagnostic and Statistical Manual 5th edition (DSM-5) substance use disorders (SUDs) include combining dependence and three of the abuse criteria into one disorder and adding a criterion indicating craving. Because DSM-IV did not include a category for nicotine abuse, little empirical support is available for aligning the nicotine use disorder criteria with the DSM-5 criteria for other SUDs.

DESIGN

Latent variable analyses, bootstrap tests and likelihood ratio tests were used to explore the unidimensionality, psychometric properties and information of the nicotine criteria.

SETTING AND PARTICIPANTS

A sample of household residents selected from the Israeli population register yielded 727 life-time cigarette smokers.

MEASUREMENTS

DSM-IV nicotine dependence criteria and proposed abuse and craving criteria, assessed with a structured interview.

FINDINGS

Three abuse criteria (hazardous use, social/interpersonal problems and neglect roles) were prevalent among smokers, formed a unidimensional latent trait with nicotine dependence criteria, were intermixed with dependence criteria across the severity spectrum and significantly increased the diagnostic information over the dependence-only model. A craving criterion was shown to fit well with the other criteria.

CONCLUSION

Similar to findings from research on other substances, nicotine dependence, abuse and craving criteria appear to derive from a common underlying dimension. The results support alignment of nicotine criteria with those for alcohol and drug use disorders in Diagnostic and Statistical Manual 5th edition.

Contextual determinants of alcohol consumption changes and preventive alcohol policies: a 12-country European study in progress

Beginning with France in the 1950s, alcohol consumption has decreased in Southern European countries with few or no preventive alcohol policy measures being implemented, while alcohol consumption has been increasing in Northern European countries where historically more restrictive alcohol control policies were in place, even though more recently they were loosened. At the same time, Central and Eastern Europe have shown an intermediate behavior. We propose that country-specific changes in alcohol consumption between 1960 and 2008 are explained by a combination of a number of factors: (1) preventive alcohol policies and (2) social, cultural, economic, and demographic determinants. This article describes the methodology of a research study designed to understand the complex interactions that have occurred throughout Europe over the past five decades. These include changes in alcohol consumption, drinking patterns and alcohol-related harm, and the actual determinants of such changes.

The Role of Ethnicity and Context: Intimate Femicide Rates Among Social Groups in Israeli Society

The study examined differences in the characteristics of intimate femicide among various groups in Israeli society between 1995 and 2007. The findings show that Israeli-born Jews and Arabs were underrepresented among intimate femicide offenders. By contrast, the proportion of Ethiopian immigrants was 21 times higher than their proportion in the total population, and immigrants from the former USSR were overrepresented by 142.1%. Ethiopian immigrants differed significantly from the other groups with regard to femicide followed by suicide: Among Ethiopian immigrants, the percentage of femicide followed by suicide was almost twice as high as the percentage found among the other groups. In addition, immigrants from the former USSR differed significantly from the other groups with regard to femicide under the influence of alcohol.

The dimensionality of alcohol use disorders: results from Israel

AIMS

To prepare for DSM-V, the structure of DSM-IV alcohol dependence and abuse criteria and a proposed additional criterion, at-risk drinking, require study in countries with low per-capita consumption, and comparison of current and lifetime results within the same sample. We investigated DSM-IV Alcohol Use Disorder (AUD) criteria in Israel, where per-capita alcohol consumption is low.

METHODS

Household residents selected from the Israeli population register (N=1338) were interviewed with the AUDADIS. Item response theory analyses were conducted using MPlus, and diagnostic thresholds were examined with the kappa statistic.

RESULTS

Dependence and abuse criteria fit a unidimensional model interspersed across the severity continuum, for both current and lifetime timeframes. Legal problems were rare and did not improve model fit. Weekly at-risk drinking reflected greater severity than in U.S. samples. When dependence and abuse criteria were combined, a diagnostic threshold of > or =3 criteria produced the best agreement with DSM-IV diagnoses (kappa>0.80).

CONCLUSION

Consistent with other studies, alcohol dependence and abuse criteria reflected a latent variable representing a single AUD. Results suggested little effect in removing legal problems and little gained by adding weekly at-risk drinking. Results contribute to knowledge about AUD criteria by examining them in a low-consumption country.

Ethnic Origin of Alcoholics Admitted to an Israeli Treatment Center

Jews have a low rate of alcohol use and abuse as reported in several different countries. In Israel over the last 10 years there has been a rising rate of alcoholism. We studied consecutive new admissions to our inpatient alcohol center, and an age and sex matched comparison group of patients consecutively admitted with schizophrenia for whether each of their four grandparents was Jewish, or non-Jewish. A significantly higher percentage of alcohol-related admissions were immigrants from the Former Soviet Union (FSU) than among schizophrenics. Among the alcohol-related admissions from the FSU, there were significantly fewer Jewish grandparents than among schizophrenia patients from the FSU. These data could support the concept that biological Jewish ethnicity has a protective effect against alcohol abuse, but are also consistent with cultural transmission of Jewish attitudes toward alcohol use.

Mental health implications of migration: a review of mental health community studies on Russian-speaking immigrants in Israel

INTRODUCTION

Since late 1980s, 1,001,726 immigrants arrived in Israel from the former Soviet Union (FSU). A review of community studies on the mental health of these immigrants is presented.

METHOD

Israeli studies from the past two decades were reviewed. Presented are findings on the prevalence of psychological distress and psychiatric disorders as well as on a number of risk factors among FSU immigrants.

RESULTS

Higher psychological distress and psychiatric morbidity were consistently found among FSU immigrants compared to the Israel-born. Social support was identified as a major stress-mitigating factor in migration. Most studies reveal the persistence of psychological distress among FSU immigrants during the first 5 years following migration, with a risk period around the second and third years following migration.

DISCUSSION

Findings from Israel corroborate some findings on immigrants in other countries but as they are limited to a single immigrant population, replication of these studies is necessary.

Review: alcohol use and problems among immigrants from the former Soviet Union in Israel

This paper attempts to deal with multiple issues, provide data, and cover the current state of alcohol use among immigrants from the Former Soviet Union (FSU) in Israel. A comprehensive review of all studies published in the professional literature (mainly in Hebrew), as well as in reports and theses in Hebrew, is presented. This is an attempt to correct the lack of information among English readers about alcohol use patterns and problems in the Russian immigrant community in Israel. This paper is the first summary of findings in the alcohol use domain-epidemiology, treatment, and homelessness in relation to FSU immigrants in Israel. The review identifies alcohol use among recent FSU immigrants as more prevalent than among the Jewish-Israeli-absorbing society, and shows that FSU immigrants are overrepresented in treatment, and that most of the homeless persons in Israel are FSU immigrants and alcoholics. The paper also describes findings from other FSU immigrant studies in related fields such as genetics, workplace issues, pregnancy, emergency rooms and driving. Recommendations for future activities include the need for special analysis and focus on the FSU immigrants in national studies, as well as further investigations about cultural effects on FSU immigrants' drinking habits.

Alcohol and tobacco consumption among Albanian immigrants in Florence

The aim of the present study was to obtain information about both drinking and smoking, as well as about alcohol consumption-related problems, among Albanians who have immigrated to Florence, Italy, after the collapse of the Communist regime in 1990. Between October 2001 and January 2002, an opportunistic sample of 141 Albanians living in the city of Florence were interviewed about their alcohol and tobacco use, as well as about their drinking pattern and health problems Interviewees were mainly (81%) males, of an average age of 28, who had been living in Italy for the last 4 years; 92.9% drank alcoholic beverages, the preferred beverages were wine and liquor, and the average daily consumption was 39.5 grams of pure alcohol-males consumed 48.1 grams per day, which was 3.5 times more than a comparable sample of Florentine males. Also Albanians overtook Florentines in terms of the rate of smokers (49.6% vs. 39.6%) and of contact with the emergency rooms (24.1% vs. 0.37%). Such high amounts of alcohol intake may contribute to the reported high rates of accidents and acts of violence involving Albanians in Florence. Some hypotheses were discussed to explain such a high level of alcohol consumption, including the sociocultural change due to emigration. The study's limitations are noted.

Educational inequalities in mortality among Israeli Jews: Changes over time in a dynamic population

Changes in educational inequalities in mortality in a country that underwent a sudden population growth were examined using two census-based longitudinal studies from Israel (I, 1983-1992, n=152,150 and II, 1995-2004, n=209,125). Relative changes in educational inequalities in mortality were assessed using mortality rates and odds ratios and their corresponding 95% confidence intervals. Decreases in mortality rates and widening relative educational inequalities in mortality were seen over time. Among recent immigrants, educational inequalities in mortality existed but to a lesser degree than for residents. The widening gap (2.5-fold) in cardiovascular disease mortality risks observed for low versus high educated middle-aged women, was particularly alarming. The observed decreasing mortality rates, indicative of a healthier society, alongside widening educational inequalities in mortality indicates uneven changes within the population.

Exposure to terrorism and Israeli youths' cigarette, alcohol, and cannabis use

OBJECTIVES

We investigated the consequences of exposure to acts of terrorism among Israeli adolescents. We examined whether exposure to terrorism predicted adolescents' use of cigarettes, alcohol (including binge drinking), and cannabis after we controlled for posttraumatic stress and depressive symptoms and background variables.

METHODS

Anonymous self-administered questionnaires were given to a random sample of 960 10th and 11th grade students (51.6% boys, 48.4% girls) in a large city in northern Israel.

RESULTS

Close physical exposure to acts of terrorism predicted higher levels of alcohol consumption (including binge drinking among drinkers) and cannabis use. These relationships remained even after we controlled for posttraumatic stress and depressive symptoms.

CONCLUSIONS

In addition to posttraumatic stress symptoms, negative consequences of terrorism exposure among adolescents included substance abuse. The similarity between our findings among Israeli adolescents and previous findings among US adults suggests cross-cultural generalizability. Given the risks for later problems from early-onset substance abuse, the consequences of terrorism exposure among adolescents merit greater research and clinical attention.

Former Soviet Union immigrant and native-born adolescents in Israel: substance use and related problem behavior

Studies on immigration and adolescence show that youth experience a variety of emotional and cognitive adjustments as well as conflicts related to acculturation and the realities of life in their new country. Such conditions place many of them at increased risk for psychosocial problems including personal stress, interpersonal conflicts, mental illness, school failure, delinquency, substance use, and other risk-taking behavior. This prospective study compares the patterns of substance use and problem behaviors among 365 at-risk adolescents born in Israel and those who immigrated to that country from the Former Soviet Union. Findings show that Former Soviet Union youth tend to have higher levels of last 30-day alcohol and ecstasy use and binge drinking. Multiple regression shows binge drinking behavior related to trading property to obtain drugs; deterioration of school achievement; selling drugs; and time spent when being absent from school and hanging around during the day. Country of origin was not found related to this behavior. Further research is needed to study substance use and related problem behavior among immigrant youth controlling for the impact of acculturation and other factors.

Severity of heroin use in Israel: comparisons between native Israelis and former Soviet Union immigrants

AIMS

This study examined drug use patterns and severity among native-Israeli and former Soviet Union (FSU) immigrants in Israel who reported heroin use.

DESIGN, SETTING AND PARTICIPANTS

a total of 272 native Israelis and 300 FSU heroin users were interviewed from 2002 to 2006 as part of a large drug use surveillance study in Israel. Individuals were sampled at an intake centre, a methadone clinic and a day-treatment facility in the Negev region of Israel. Participants were assessed using the Addiction Severity Index, fifth edition. Native Israeli and FSU users were compared within two groups: those interviewed at intake and those interviewed in treatment.

FINDINGS

Overall, ASI composite scores suggested generally comparable levels of addiction severity between the two ethnic groups. Native-born Israelis reported more years of heroin use; however, the FSU immigrants reported longer use of other opiates. The FSU reported significantly more heroin use by injection, and a significantly higher rate of hepatitis C and other chronic medical problems. Comparisons by gender within each group revealed higher drug severity scores for females (native-born Israeli and FSU combined). Females in the intake group had significantly higher severity scores in the areas of employment and psychiatric status when compared to individuals who had been in treatment for some time.

CONCLUSIONS

Except for higher levels of alcohol use, the FSU did not have more severe drug problems than the native Israelis as measured by ASI severity scores. Injection use among FSU, however, is a critical public health problem, especially given the well-established link between injection drug use, hepatitis C and HIV/AIDS.

Psychotropic drug use in Israel: results from the national health survey

BACKGROUND

Despite increasing psychotropic drug prescriptions worldwide, little is known about utilization of these medications in the general population in Israel. We examined psychotropic drug use in the general population of Israel and the patterns of use among individuals with different DSM-IV diagnoses of 12-month mental disorders.

METHOD

A representative sample was derived from the National Population Register of noninstitutionalized residents aged 21 and older. Face-to-face interviews were conducted from May 2003 to April 2004. Individuals were asked about any psychotropic drug use in the past 12 months. DSM-IV disorders were assessed using a revised version of the World Health Organization's Composite International Diagnostic Interview.

RESULTS

Psychotropic drug utilization was observed in 6.9% of the general population and in 19.6% of individuals with any 12-month psychiatric disorder. The extent of use varied according to sociodemographic variables and the specific DSM-IV diagnostic categories. Among individuals with a 12-month diagnosis of pure major depression, only 13.6% received any antidepressants within the same period; exclusive use of antidepressants was 5.7%, while 3.3% of the individuals used only anxiolytics.

CONCLUSION

Similar to findings in other European countries, our findings suggest that the majority of individuals diagnosed with a common mental disorder are not being treated with psychotropic drugs or are being inappropriately treated.

Ethnicity versus migration: two hypotheses about the psychosocial adjustment of immigrant adolescents

STUDY BACKGROUND AND AIMS: This study investigates the psychosocial adjustment of immigrant adolescents and examines two hypotheses: the ethnicity hypothesis, which suggests that ethnic background determines the psychosocial reactions of immigrant adolescents; and the migration hypothesis, which suggests that the migration experience determines such reactions.

METHODS

The study compared four groups of respondents: first-generation immigrants (N = 63) and second-generation immigrants (N = 64) from the former Soviet Union (FSU) in Israel; and Jewish (N = 212) and non-Jewish (N = 184) adolescents in the FSU. A self-report questionnaire administered to the respondents collected demographic, educational and psychological data using standardised scales.

RESULTS

Immigrant adolescents reported higher psychological distress, lower self-esteem and higher alchohol consumption than non-immigrant adolescents. Second-generation immigrants generally showed a higher level of functioning than first-generation immigrants. These findings favor the migration hypothesis.

CONCLUSIONS

Our findings support the widely accepted view of migration as a potentially distress-provoking experience. They suggest that psychological reactions of immigrant adolescents, and in fact all immigrants, are best interpreted as reactive and are related to the universal stressful qualities of the migration experience. Further multiethnic comparative studies, however, are needed to confirm and refine these findings.

Israel 2000: Immigration and Gender Differences in Alcohol Consumption

The present study addresses the association between immigration from the former Soviet Union (FSU) and gender and alcohol consumption among a representative sample of young adults in Israel 2000. Previous studies that were conducted on FSU immigrants to Israel indicate higher consumption than that of resident Israelis and immigrants of earlier periods. The current study aims to assess alcohol consumption among FSU and resident Israelis five years later to determine whether the discrepancy in alcohol consumption stays consistent or reduces. In addition, gender differences in alcohol consumption among the Israeli society were examined as well, as a special case of socio-culture differences. The data came from the 2000 national survey of drinking in Israel. Of 5,004 Jewish Israelis, 532 were immigrants from the FSU who arrived since 1989, and 4,472 were resident Israelis. The FSU group was compared with resident Israelis, and males were compared to females on several drinking variables. Logistic regression was the principal method of analysis. Demographics and cultural variables as main effects or in interaction with FSU and gender were controlled. The FSU group was significantly more likely to report drinking in the last twelve months plus drinking in the last thirty days than resident Israelis. Women's reported drinking in the last twelve months was one fourth of men's and during the past thirty days was one fifth of men's. Further investigation on the associations between the success of FSU acculturation in the Israeli society and drinking patterns as well as attitudes toward women and gender differences in alcohol consumption may provide explanations for gender and immigration gaps in alcohol consumption.