Nutrition, tobacco use, and physical activity in the West Bank, occupied Palestinian territory: an environmental profile of community health

Abstract

<h3>Background</h3> With the epidemiological transition in the occupied Palestinian territory (oPt), cardiovascular diseases are becoming the leading cause of death. This increase might be partly attributed to changes in tobacco use, physical activity, and nutrition adversely affecting the health of the Palestinian population. Our aim is to describe the environmental factors that might unfavourably contribute to the health-related behaviours of communities in the oPt. <h3>Methods</h3> We used the environmental profile of a community's health (EPOCH) questionnaire to gather data about walking and environmental factors that affect tobacco use and diet in the Palestinian population. The questionnaire was modified for use in the oPt—eg, because Israeli checkpoints create a barrier to walking through or between communities, we included information about the presence and distance of the checkpoints from community centres. 24 communities (nine urban, nine rural, and six refugee camps) were randomly selected from the north, centre, and south of the West Bank. Trained researchers directly noted and systematically recorded physical aspects of the environment, using standardised definitions from the EPOCH questionnaire. This study was approved by the Research Ethics Board at McMaster University, Hamilton, ON, Canada, and the Institute of Community and Public Health Ethical Review Committee, West Bank. <h3>Findings</h3> 17 (71%) of 24 stores had one or more advertisement for unhealthy food and soft drinks; advertisements were more common in urban communities and refugee camps than in rural communities (seven [78%], five [83%], and five [56%], respectively). Food labelling on packets of locally made unhealthy food complied with the Palestinian laws of packaged food items, whereas imported packets did not. Different brands of cigarettes (mean 16 [SD 7]) were widely available in the stores, with urban communities having the highest choice (23 [5] <i>vs</i> 12 [4] in rural and 12 [8] in refugee-camp communities). Local and imported packets of cigarettes did not comply with the Palestinian smoking laws or the WHO Framework Convention on Tobacco Control—eg, warning labels on packets covered less than 20% of the area and none stated the percentage of nicotine or tar. Pavements were present on at least one side of the roads in five (21%) communities and were less common and of poor quality in rural communities. The mean score for pavement quality (maximum score of 10 indicating highest quality) was 5 (range 1–9) in the 24 communities: 8 (5–9) in urban, 3 (1–6) in rural, and 4 (1–7) in refugee camps. In ten (42%) communities (five [56%] urban, one [11%] rural, and four [67%] refugee camp), individuals had to pass through an Israeli army checkpoint to enter the community; checkpoints were a mean distance of 9 km (SD 8) from the community centre. <h3>Interpretation</h3> These findings indicate several environmental factors that could be affecting the health-related behaviours of the Palestinian communities. Existing policies for tobacco and food labelling should be enforced and policies need to be developed to improve unrestricted walking in the local environment. <h3>Funding</h3> Population Health Research Institute.