Alcohol drinking patterns among Jewish and Arab men and women in Israel

Associations of the COVID-19 burden and various comorbidities of different ethnic groups in Israel: a cross-sectional study

Coronavirus disease (COVID-19) is highly transmissible between human beings. We examined differences in the core families with COVID-19 severity and mortality and comorbidities between Arab and Jews and explored the factors associated with COVID-19 severity and mortality to find a genetic component. A cross-sectional study was conducted among 2240 COVID-19 patients (> 18 years of age) randomly selected by online panels and questionnaires in the native language (Hebrew or Arabic) during March 2021-June 2022. Multivariable linear regression models were used to assess correlations with COVID-19 disease severity and mortality. Overall, 1549 (69%) were Arabs and 691 (31%) were Jews. The proportion of participants who died from COVID-19 was higher among Arabs compared with Jews (66% vs. 59%), P < 0.001. The mean number of deaths from COVID-19 and patients with severe COVID-19 was higher in ultra-Orthodox Jewish, non-academic core families and those who lived in the city residence compared with secular, academic core families and who live in the village residence, P < 0.001. A multivariable linear regression model showed a significant association between metabolic, kidney, cardiovascular, and respiratory diseases with COVID-19 severity (B coefficient - 0.43, B coefficient - 0.53, B coefficient - 0.53, B coefficient - 0.42, respectively) and COVID-19 mortality (B coefficient - 0.51, B coefficient - 0.64, B coefficient - 0.67, B coefficient - 0.34, respectively), P < 0.001. COVID-19 severity and mortality were highly associated with comorbidities, ethnicity, social and environmental factors. Furthermore, we believe that genetic factors also contribute to the increase in COVID-19 severity and mortality and the differences rates of these between Arabs and Jews in Israel.

Credibility assessments of alibi accounts: the role of cultural intergroup bias

Research has shown that judges and jurors are influenced by suspect ethnicity and that they might discriminate against out-group suspects in making decisions. This study examined the tendency to favor in-group members, as predicted by social identity theory, in assessing alibi credibility. Forty Israeli-Jewish and 40 Israeli-Arab participants assessed the credibility of an alibi statement provided by a suspect who was either Israeli-Jewish or Israeli-Arab. Findings show that participants were more likely to believe the alibi when it was provided by an in-group suspect than by an out-group suspect, supporting intergroup bias in alibi credibility assessments. Practical and theoretical implications are discussed.

Slowing the Tide of Alcohol Use Disorders

Alcohol use disorders (AUDs)-a spectrum including at-risk drinking, alcohol abuse, dependence, and addiction-is a highly prevalent problem worldwide with a substantial economic impact. The toll of alcohol on individual health and healthcare systems is devastating. Alcohol is estimated to be the fifth leading risk factor for global disability-adjusted life years. Tackling the problem of AUD requires a comprehensive strategy that includes solid action on price, availability, and marketing of alcohol. Restricting or banning alcohol advertising may reduce exposure to the risk posed by alcohol at the individual and general population level. Warning labels about the cancer risks associated with drinking have a high degree of public support and may be an inexpensive and acceptable way to educate the public. Religiosity may reduce risk behaviors and contribute to health decision making related to alcohol use.

Alcohol and Islam: An Overview

Alcohol and Islam is a relatively understudied topic, although alcohol abuse is a significant social problem both in Muslim majority countries and among Muslim minorities. Questions of religious identity as they relate to food and drink prescriptions and proscriptions also make alcohol and Islam a worthwhile topic. This article offers a general overview of alcohol and Islam. It briefly introduces alcohol and Islam in history; examines the main Islamic religious sources (the Quran, the sayings and practices of the Prophet Muhammad, and Islamic law); analyzes World Health Organization statistics on contemporary patterns of abstention and alcohol consumption in Muslim majority countries; reviews the social science literature on alcohol studies in Muslim settings; presents Saudi Arabia and Turkey as opposite extremes of prohibition and permissiveness in Muslim majority countries; offers France as a case study of the effects of migration on abstention and drinking patterns of Muslims in minority settings (about a quarter of all Muslims live as religious minorities); and looks at the rationales that some Muslims give for drinking. In conclusion, the article places the problem of alcohol prohibition in a larger context of how to approach food and drink prescriptions and proscriptions; it also cautions against overestimating the influence of Islam, and suggests an agenda for future studies of alcohol-related beliefs and behaviors among Muslims.

Religion, Alcohol Use and Risk Drinking Among Canadian Adults Living in Ontario

This research examines (1) the association between risk drinking and religious affiliation and (2) differences between religions for risk drinking among adults living in Ontario, Canada, for Christians, Buddhists, Sikhs, Muslims, Hindus, Jews, other religious groups and the non-religious. Data are based on telephone interviews with 16,596 respondents and are derived from multiple cycles (2005-2011) of the Centre for Addiction and Mental Health's (CAMH) Monitor survey, an ongoing cross-sectional survey of adults in Ontario, Canada, aged 18 years and older. Data were analysed using bivariate cross-tabulations, Mann-Whitney U nonparametric test and logistic regression. Alcohol use and risk drinking occur among members of all religious groups; however, the rate of drinking ranges widely. Risk drinking is significantly associated with religion. When compared to the No religion/Atheist group, several religious groups (Baptist, Christian, Hindu, Jehovah's Witness, Jewish, Muslim/Islam, Non-denominational, Pentecostal, Sikh and Other religion) in our sample have significantly lower odds of risk drinking. Risk drinkers also attended significantly fewer services among several religions. Results suggest that there are differences in the risk drinking rates among Canadian adults, living in Ontario, by religion. It appears that religious traditions of prohibition and abstention do hold sway among Canadian adults for some religious groups.

Cross-Cultural Validity in Self-Reported Alcohol Use

BACKGROUND AND AIM

Little evidence is available on whether respondents from divergent sociocultural populations report alcohol consumption in systematically similar ways. Therefore, this study examined whether the validity of self-reported alcohol use differed between Arab and Jewish Israeli pub patrons.

METHODS

The analytical sample consisted of 227 Arab and 900 Jewish Israeli pub patrons who were approached as they left pubs and asked to record their Breath Alcohol Content (BrAC) value and complete a questionnaire that probed into their alcohol use. Validity of self-reported alcohol use across the 2 groups was examined by testing the discrepancy in concordance between the self-reported number of drinks and BrAC scores through simple Pearson correlations and by performing a multi-group measurement invariance (MI) comparison.

RESULTS

The Pearson correlation between the self-reported number of drinks and BrAC by the ethno-cultural group was almost identical across groups (Jews: r = 0.47, p < 0.01, df = 898; Arabs: r = 0.42, p < 0.01, df = 225). MI test results further confirmed that the factor loadings of the 2 drinking measures are similar across the 2 ethno-cultural groups.

CONCLUSIONS

Self-reported alcohol consumption gives cross-culturally valid and acceptable estimates of alcohol consumption in this sample of Israeli Arabs and Jews.

The Role of Religion in the Recovery from Alcohol and Substance Abuse Among Jordanian Adults

The purpose of this study is to understand religious factors role during recovery period among Jordanian receiving treatment for alcohol and substances abuse. Participants were asked to answer open-ended questions related to role of religion on their recovery from alcohol and substances abuse. Content analysis was used to explore the role of religion on their recovery process. One hundred and forty-six clients from two treatment centers participated with two main themes that emerged from the analysis: role of religion and role of religious men. Religion not only helps during the recovery process, but also is considered as a protector from drug and alcohol abuse in the future.

Explaining the frequency of alcohol consumption in a conflict zone: Jews and Palestinians in Israel

Experiencing stress and exposure to terrorism may have an adverse effect on health risk behaviors. Few studies have examined alcohol use among adults living in Israel under chronic, stressful terrorism-related conditions. In this study, we examined the relationships of demographics, past stressful events, and terrorism exposure to the frequency of alcohol use and the mediating roles of depressive and post-traumatic stress disorder (PTSD) symptoms. We used three waves of data from a 2007-2008 nationally representative sample of Jewish and Palestinian adults in Israel. We assessed past stressful events, in addition to direct and indirect exposures to terrorism. Results indicated that past stressful events and exposure to terrorism were not directly associated with alcohol use, but were indirectly associated and mediated by depressive and PTSD symptomology. Mental health symptoms were differentially associated with alcohol use. More frequent drinking was mediated by higher levels of depression, including for women and Palestinians; however, PTSD symptom severity was related to less frequent drinking. Mental health may play a prominent role in the frequency of alcohol use among adults exposed to terrorism in Israel. Alcohol use, as a coping mechanism, may differ by demographic characteristics (gender and ethnicity) and psychological symptomology for adults living in a conflict zone in Israel.

Trends in dual diagnosis of severe mental illness and substance use disorders, 1996-2010, Israel

OBJECTIVES

(1) To examine the trends in the incidence of dual diagnosis (DD) of severe mental illness and substance-related disorders among inpatients in Israel, and (2) the demographic and clinical correlates of DD patients.

METHOD

Using data from the National Psychiatric Case Register, we identified 56,774 inpatients aged 15-64 whose first psychiatric hospitalization occurred between 1996 and 2010. We compared the characteristics of inpatients having DD with drugs, alcohol or drug/alcohol abuse with those with mental disorder only.

RESULTS

Over the period, DD with drugs decreased from 8.2% in 1996 to 6% in 2010; DD with alcohol increased from 3% to 4% and DD with drugs/alcohol from 2% to 4%. DD with drugs was highest, whereas DD with alcohol was lowest for the youngest age- group in 1996 but increased to the same as other age-groups in 2006-2010. Male gender, a previous suicide attempt, compulsory hospitalizations and marital status were positive predictors for all DD. Immigrant status was a positive predictor of DD with alcohol, but the opposite for DD with drugs; being Jewish and psychotic diagnosis was a positive predictor of DD with drugs, but negative for DD with alcohol.

CONCLUSIONS

Over the study period, DD with drugs has decreased among young patients, although it is still higher than among older groups. However, DD with alcohol or drugs/alcohol has increased in the younger group. The clinical-demographic profile of DD patients was similar to that from the relevant literature, except for immigrant status that was negatively associated with DD with drugs.

Alcohol consumption among Arabs in Israel: a qualitative study

BACKGROUND

The Israeli society is a unique setting in which the Arabs are exposed to western alcohol consumption norms while living in Arab communities where alcohol consumption is not accepted.

OBJECTIVES

To characterize Arab Muslim, Druze and Christian alcohol consumption behaviors and contingencies while being exposed to western style alcohol consumption.

METHODS

This study was a phenomenological qualitative study interviewing six focus groups and 13 individual Arab Muslims, Christians and Druze. Themes and categories were identified using qualitative methodology analysis.

RESULTS

Two concurrent contingencies exist for Arab Muslim men: on the one hand they describe pressure to drink because of social norms, and on the other hand they are reprehended for drinking, because of the religious interdiction. Therefore, they hide their drinking in secluded places. In addition, participants reported more heavy drinking among Muslim Men. Arab Christians reported drinking openly especially among men. Women do not drink and are looked down upon if they drink. Drinking may be viewed as a stage in life that a Muslim boy or young man goes through, he is expected to grow out of this stage and stop drinking while becoming religious. Conclusions/importance: Due to Muslim laws prohibiting alcohol consumption, alcohol consumption is not high, however it does exist especially among young men and when they drink they tend to drink heavily, more than the Arab Christians. Therefore, there is a need for interventions targeting younger Muslim men, to establish moderate drinking behaviors, if they chose to drink.

Examining differences in drinking patterns among Jewish and Arab university students in Israel

OBJECTIVES

Worldwide there is a dearth of studies examining drinking patterns in Arabs and how these compare to other populations. The few studies that exist have suggested distinct drinking patterns in Arabs, with not only high rates of abstinence but also high rates of heavy drinking among current drinkers. No studies have yet examined potential socio-cognitive mechanisms that may contribute to this distinct drinking pattern. Israel represents a unique and valuable resource for studying Arab population drinking patterns because Israeli Arabs are nonimmigrants living in areas where exposure to Western lifestyles, including alcohol consumption, is prevalent. The current study was set out to examine differences in alcohol consumption in a convenience sample of 1310 Jewish and Arab students from Israeli universities and colleges and to explore alcohol expectancies as potential mediators of ethno-religious differences.

DESIGN

Logistic regressions were used to produce odds ratios and 95% confidence intervals to test differences between Jewish and Arab students on binary outcomes (lifetime, last month, and heavy drinking). Mediation of ethno-religious differences by alcohol expectancies was tested with bootstrapping procedures.

RESULTS

Results show that while Israeli Arab students tend to be more likely to abstain from alcohol than Israeli Jewish students, among current drinkers, Israeli Arab students are at a particular high risk of heavy drinking. Results also show that this is partly mediated by the expectancy that alcohol only influences the drinker at high levels of intake.

CONCLUSION

The current study confirms distinct Arab drinking patterns found in previous studies. The present study is the first demonstration that drinking expectations mediate ethno-religious differences in heavy drinking among Israeli Arabs and Jews. This work contributes to the understanding of ethno-religious group differences in harmful drinking, potentially informing future etiologic research and public health interventions aimed at reducing alcohol-related harm.

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.

Substance abuse In Middle Eastern adolescents living in two different countries: spiritual, cultural, family and personal factors

It is estimated that the percentage of students using illicit substances by sixth grade has tripled over the last decade not only in developed countries but in developing countries as well probably due to the transition to a more Western society. Although much has been done to understand the mechanisms underlying substance abuse, few studies have been conducted with minority ethnic and religious groups such as Middle Eastern Youth. The primary goal of this study was to determine whether there are differences in factors contributing to substance abuse in adolescents from Lebanon versus the U.S.A. and to decipher the role of spirituality, religion, and culture among other factors that may influence substance abuse. A correlational cross-sectional design was used with adolescents living in two different countries: Los Angeles, California and Beirut, Lebanon. Muslim adolescents had significantly less rates of alcohol and substance use than Christians in both Lebanon and Los Angeles. More years lived in the U.S.A. increases the likelihood of abuse for both Muslims and Christians. Attachment to God and family was negatively associated with substance abuse. These results among others facilitate a better understanding of the influence of culture, religion, family and personal factors on substance abuse. Culturally sensitive interventions could benefit from the findings of this pilot study.

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.

Tobacco and alcohol use among Arab adults in Israel: findings from a nationwide study

OBJECTIVE

This comprehensive study focuses exclusively on adult Arabs in Israel and is aimed at examining tobacco and alcohol use rates and their predictors.

METHODS

One thousand and two hundred Arab adults were randomly sampled via cluster sampling and interviewed using a structured questionnaire.

RESULTS

Forty-four per cent of respondents reported tobacco use while 39% reported alcohol use. There were notable gender gaps in use, as well as differences between Muslims and Christians. Odds of using both tobacco and alcohol increased with having a greater tendency towards risk-taking and more time spent partying. Odds of alcohol use also increased with having positive attitudes towards use, lower perceived risk and greater intention to use.

CONCLUSIONS

These findings add a more complete understanding to the phenomenon of tobacco and alcohol use among Arab adults in Israel and carry important implications for future research and practice.

Respondent-driven sampling of Muslim undergraduate U.S. college students and alcohol use: pilot study

PURPOSE

Prevention of alcohol abuse requires information about all demographic groups. However, little is known about drinking among people affiliated with proscriptive religions due to omission of religious affiliation in many surveys and challenges sampling them. Our objective was to pilot a sampling technique frequently used in the HIV literature, respondent-driven sampling, to assess potential association of alcohol use with religiosity, personal proscriptive belief, and social influences among Muslim U.S. college students.

METHODS

Self-identified Muslim undergraduate students (N = 156) at one urban commuter university completed a web-based survey.

RESULTS

Prevalence adjusted for sampling was 9.1 % (95 % CI: 0.2-17.1 %) with in-group recruitment of 0.36 for drinkers and 0.43 for abstainers. In unadjusted analyses, students who were lifetime abstainers were more likely than drinkers to hold personal proscriptive belief and strongly agree with a measure of private religiosity. There was no difference on public religiosity measures between groups. Lifelong abstainers were more likely to report fewer students, fewer Muslim students, and fewer of their friends drank alcohol. They also were more likely to report that they attended high school with more Muslims and currently live in neighborhoods with more Muslims.

CONCLUSIONS

In this pilot study, lifetime abstinence was associated with high private religiosity, personal proscriptive religious beliefs, and more proscriptive social influences. The findings suggest that respondent-driven sampling may be feasible in recruiting Muslim students. However, validation against other sampling techniques is needed.

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.

Oral and pharyngeal cancer among the Arab population in Israel from 1970 to 2006

BACKGROUND

Israeli Arabs are considered as a developing society characterized by poverty and high levels of smoking among men. The purpose of this study was to describe their incidence, mortality and survival rates for oral and pharyngeal cancer between the years 1970-2006. Studies such as this in the Arab world, where the population is almost the same as the Arab population in Israel, are rare.

METHODS

The incidence and survival data were derived from all relevant registered data at the National Cancer Registry. The group of lesions included cancer of the lips, tongue, buccal mucosa, floor of the mouth, salivary glands, gums, palate and pharynx. Morphological description was according to WHO classification.

RESULTS

Most diagnosed patients were male. The mean age was 54.4 years, and mean years of survival were 3.83. The oropharynx was the most common site (28.3%) while the palate was the least frequent (3.12%). Squamous cell carcinoma (SCC) was the most common histological feature (66.3%), while basal cell carcinoma (BCC) was the least (3.9%). The overall 5 years survival rate was 59.4%, this being highest for BCC (82.1%), while SCC was significantly lower (56.2%) (p<0.001). Lip cancers survived better than other sites.

CONCLUSIONS

Data from this society are similar to other developing societies in the majority of the results. The incidence of oral and pharyngeal cancer is lower among the Arab population, in comparison to the Jewish population in Israel.

Ethnic differences in patterns of secondhand smoke exposure among adolescents in Israel

INTRODUCTION

Adolescent secondhand smoke exposure (SHSe) is associated with smoking initiation and independently damages health.

METHODS

We used data from the school-based 2003-2004 Israel National Health and Nutrition Youth survey (MABAT) to examine patterns and determinants of SHSe in a multiethnic sample of Israeli adolescents. School and child response rates were high (school: 91.8%, child: 87.9%), with 6,274 participants. We used generalized estimating equations to examine SHSe determinants.

RESULTS

Most Israeli adolescents were exposed to SHS (total: 85.6%; home: 40%; school: 31.4%; entertainment: 73.3%; other: 16.3%). Exposure patterns differed between the Jewish and non-Jewish sectors. Jews were more frequently exposed at school and entertainment venues than were non-Jews but were less frequently exposed at home. Druze were the least exposed and non-Arab Christians the most exposed. Secular Jews were more exposed than were religious Jews; the opposite was true among Arabs. Children of less-educated fathers were exposed more than children of more-educated fathers. Adolescents who smoked were more exposed than were nonsmokers.

CONCLUSIONS

The high levels of SHSe among Israeli adolescents were characterized by different patterns of exposure among different population groups. Interventions to reduce adolescent SHSe, with appropriate tailoring, are urgently needed. These findings provide support for sustainable implementation of the recent governmentally approved tobacco control plan, which includes extended legislation for, and increased enforcement of, laws about smoking bans in schools and entertainment venues. Researchers elsewhere should be aware that levels and patterns of SHSe may vary greatly by subpopulation.

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.

Squamous cell carcinoma of the oral tongue in patients over 75 years old

BACKGROUND AND AIMS

Squamous cell carcinoma (SCC) of the oral tongue is one of the most frequent head and neck cancers. The over-70-year age group is the fastest growing segment of the population. Age, however, is not considered a prognostic factor in oral tongue SCC. This study investigated the clinical and histopathological characteristics, disease course, and outcome of SCC of the oral tongue in patients over 75 years old compared with younger patients.

METHODS

We reviewed the files of 85 patients with histologically proven SCC of the oral tongue who were treated in our department in 1992-2007 and followed for a minimum of 2 years. Findings were compared between those aged 75 years or more and younger patients.

RESULTS

Twenty-eight patients (33%) were aged 75 to 94 years (average 80.5±4.5 yrs), including 14 who were over 80 years old, and 57 patients were aged 15-74 years (average 51.1±18.2 yrs). No statistically significant differences were found between the groups in clinical or histopathological characteristics or patient outcome. The 5-year disease-free survival rate was 65% for patients over 75 and 58% for younger patients. Corresponding rates for 5-year disease-specific survival were 69% and 70%. These differences were not statistically significant.

CONCLUSIONS

Patients over 75 with oral tongue SCC should be managed like younger patients in terms of clinical staging and co-morbidities. They should be given a chance for treatment, as their prognosis is no different from that of younger patients.

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.

Druze adolescent dropouts in Israel and their use of psychoactive substances

The current study examines rates of psychoactive substance use among Druze adolescent dropouts and links between use rates and socio-demographic, interpersonal, cognitive, and personality characteristics. 204 adolescents took part in the study in late 2004. Approximately 21% had consumed tobacco 10 times or more in the last year, 25% reported consuming alcohol in the same timeframe, and nearly 6% used an illegal substance at least once in the last year. Boys had significantly higher rates of alcohol and tobacco use than girls. Religiosity, attitudes and behavioral intentions regarding use were also linked with consumption of the three substances.

Acculturation and polysubstance abuse in Arab-American treatment clients

Acculturation to U.S. culture by Latinos and Asian Americans has been associated with increased prevalence of substance abuse. However, little is known about the association between acculturation and substance use among Arab Americans, or more specifically, among Arab-American treatment clients. In 156 Arab-American male treatment clients, we found that higher levels of U.S. acculturation were positively associated with increased prevalence of polysubstance abuse. This first report on a large series of Arab-American clients also found considerable within-group variability. These results can be used to develop treatment plans and work-force training on the importance of U.S. acculturation and variability within Arab Americans.

Psychoactive substance use among Arab adolescent school dropouts in Israel: a phenomenon and its implications

This comprehensive study is the first to examine rates of legal and illegal psychoactive substance use and their predictors specifically among Arab adolescent school dropouts. It investigates the links between sociodemographic, interpersonal, cognitive and personality characteristics and use rates. Four hundred and seventy-six Arab adolescents aged 12-18 from throughout Israel, who had dropped out of school, participated in the study in late 2004. Sampling was done using a cluster method in order to choose specific localities. Participants completed self-report questionnaires assessing substance use and other variables. Legal substances--alcohol and tobacco--were used by 36% and 30% of the respondents, respectively, in the previous year. Being male, non-religious and having higher behavioural intentions and positive attitudes regarding use increased the odds of substance use. The best predictors of alcohol use were gender and religiosity, each raising the odds of use by 3.5. The best predictor of tobacco use was gender, raising the odds by 12.7. The best predictors of illegal use, behavioural intentions and risk perception, each doubled the odds of use. These and other results facilitate a better understanding of substance use among Arab adolescent dropouts and can foster the development of appropriate prevention and intervention programmes for this underserved population.

Patterns of psychoactive substance use among Arab secondary school students in Israel

The current study examines patterns and trends in the use of psychoactive substances among Arab secondary school students throughout Israel. Data were collected in late 2004 using self-report questionnaires. The sample consisted of 2,944 students, Grades 7 through 12. Participants were sampled using a cluster method from schools throughout Israel. Results indicate higher use rates among males and among low-religiosity adolescents, as well as a strong link among attitudes, risk perception, behavioral intentions, and substance use. The study's implications and limitations, as well as possibilities for future research, are discussed. This study was funded by the Israel Anti-Drug Authority.

The Protective Effect of Marriage on Mortality in a Dynamic Society

PURPOSE

We sought to assess whether the protective effect of marriage on overall and cause-specific mortality has changed over time in a dynamic society.

METHODS

Data from the census-based Israel Longitudinal Studies (ILMS) I (1983-1992) and II (1995-2004) were analyzed. Cox proportional hazard modeling adjusting for sociodemographic factors was applied to 152,150 and 209,125 individuals, ages 45-89 years from the ILMS I and II, respectively. During each study period 31,749 (ILMS I) and 37,656 (ILMS II) deaths were reported.

RESULTS

Mortality inequalities by marital status remained significant and widened over time for middle-aged and elderly men and women. Changes in cause-specific mortality indicated a widening of cardiovascular disease mortality inequalities by marital status. An increasing trend was also noted for deaths from cancer (+25%) and other causes (+38%, p < 0.05) in middle-aged men, but not women (cancer = 0%; other causes = -3%).

CONCLUSIONS

The stronger beneficial effect of marriage over time may reflect societal changes that have differentially affected men and women.

Living in the shadow of terrorism: Psychological distress and alcohol use among religious and non-religious adolescents in Jerusalem

This study examines the effects of prolonged exposure to terrorism in 600 religious and non-religious Jewish adolescents living in Jerusalem, particularly post-traumatic stress (PTS) symptoms, depressive symptoms, alcohol use, coping strategies and social support. The youth in Jerusalem reported high exposure to terrorist acts. This exposure was associated with high PTS, depressive symptoms and alcohol use. Despite an apparently greater exposure to terrorism, religious adolescents reported lower levels of PTS and alcohol consumption, but similar levels of depressive symptoms to non-religious adolescents. Problem-solving coping predicted higher depressive symptoms for religious adolescents exposed to terrorism but not for similarly exposed non-religious adolescents. In contrast, emotion-focused coping predicted more alcohol consumption among highly exposed non-religious adolescents, while emotion-focused coping predicted more alcohol consumption among religious adolescents with low exposure. The overall findings suggest that religiosity may buffer the negative consequences of exposure in other ways than through coping or support.

Osteoporosis health-related behavior among healthy peri-menopausal and post-menopausal Israeli Jewish and Arab women

BACKGROUND AND AIMS

Health practices such as calcium-rich diet and exercise, are associated with the prevention of osteoporosis. Since studies showed that ethnic minorities are less involved in preventive practices, the aim of this study was to examine patterns and correlates of osteoporosis health-related behavior in Israeli-Jewish and Arab women.

METHODS

Interviews were conducted with 261 women aged 45 and older (70% Jewish). Health behavior included: physical activity, smoking, alcohol consumption, use of hormone replacement therapy, screening behavior, calcium intake, pharmacological prevention, and help-seeking patterns. Correlates included demographic variables, health characteristics (menopausal status, family history of osteoporosis), knowledge about osteoporosis, and beliefs (susceptibility and worries about developing osteoporosis).

RESULTS

Compared with Jewish participants, a lower percentage of Arab women engaged in physical activity, were on HRT, and had had bone density examinations. Their overall calcium intake was significantly lower as well. Levels of knowledge were moderate to low for the whole group, but more so among Arab women. Engaging in physical activities was associated with being menopausal and with having more knowledge among Jewish women, and with having more knowledge and lower rates of concern among Arab women.

CONCLUSIONS

Expanding knowledge about osteoporosis may prove beneficial for increasing participation in preventive behavior in both groups. Special attention should be paid to different levels of education and to differences in subjects' needs and accessibility to sources of information.

An Expanded Evaluation of the Relationship of Four Alleles to the Level of Response to Alcohol and the Alcoholism Risk

BACKGROUND

Alcoholism is a complex, genetically influenced disorder the cause of which may be better understood through the study of genetically influenced phenotypes that mediate the risk. One such intermediate phenotype is the low level of response (LR) to alcohol. This project used a case-control approach to search for genes that may contribute to LR.

METHODS

Data were available from alcohol challenges at approximately age 20 and regarding the development of alcohol use disorders over the subsequent 20 years for 85 men, including 40 reported in a previous genetic analysis. LR was evaluated using oral consumption of 0.75 ml/kg of alcohol, after which changes in subjective feelings of intoxication and body sway were measured. Alcohol abuse and dependence were diagnosed by DSM-III-R criteria through structured interviews administered to both the participant and an informant (usually the spouse) 10, 15, and 20 years after initial testing. Four polymorphisms were evaluated, including the serotonin transporter HTTLPR promoter ins/del, GABAAalpha6 Pro385Ser, NPY Leu7Pro, and catalase 262C>T. Two of these, HTTLPR and GABAAalpha6 Pro385Ser, had been previously associated with LR and alcoholism in a preliminary study.

RESULTS

The HTTLPR L allele was significantly related to both the LR and alcoholism in an allele-dosage (stepwise) manner. Furthermore, the association remained when L alleles were subdivided into recently reported functional subtypes: the lowest LR was associated with genotypes correlated with the highest serotonin transporter expression. The GABAAalpha6 Ser385 allele showed a nonsignificant trend for association to a low LR, as had been previously observed, although the Ser385 allele is uncommon, and only 18 heterozygotes were in the current group. However, the six men with both LL and Pro385/Ser385 genotypes had the lowest LR, and each had developed alcoholism during follow-up. Neither NPY nor catalase was associated with either LR or alcoholic outcomes, although the sample did not have sufficient power for definitive conclusions.

CONCLUSIONS

This report strengthens the support for a relationship between the HTTLPR L and GABAAalpha6 Ser385 alleles to low alcohol LR and to alcoholism in a prospectively studied cohort evaluated for LR in young adulthood and before the onset of alcohol dependence.

Twenty-year trends in illicit drug use among young Israelis completing military duty

AIM

This study examines patterns of illicit drug use in a national sample of young men and women in Israel over a 20-year period.

DESIGN

Annual cross-sectional data are analysed from an ongoing systematic sample of soldiers being discharged from active military service during the years 1982-2001.

SETTING

An anonymous questionnaire is self-administered to soldiers on the day of discharge in an unsupervised setting.

PARTICIPANTS

Between 1200 and 2800 individuals participated in the survey annually. A total of 40 518 people were included in the analysis. This sample frame is reflective of all Israel Defense Forces (IDF) releasees below the rank of Captain. Military recruits in Israel comprised about 80% of the country's 18-year-old Jewish male cohort in any given year, and about two-thirds of the female population of this age.

FINDINGS

Time-trends of drug use in Israel parallel those in the United States and European countries, although at much lower rates. Several indicators suggest a recent increase, particularly among women. Drug use is strongly inversely related to education level. Marijuana accounts for 65-75% of drug use in this young adult population.

CONCLUSION

Jewish cultural background and the military policy of zero tolerance are assumed contributors to the low drug use levels. Recent upward trends suggest that intensified prevention, surveillance and research efforts are in order.