Israeli Adults Research Articles

Abstract P301: Diet Quality and Frailty in Israeli Adults 65 Years or Older

Background: Frailty represents a transition state between successful aging and disability. Nutrition may promote successful aging. However, only a few studies explicitly examined the association between overall diet quality and frailty in the oldest old age group. Methods: We studied an older adult (65+) cohort that participated in the Israeli National Health and Nutrition Survey of Older Adults in 2005-2006 (T1, N=1,799). Survivors of T1 were contacted, and from 2017-2019, an extensive interview and a functional assessment were conducted (T2) among 604 past participants. A 24-hour dietary recall, assessed at T1, was used to calculate the healthy eating index (HEI-2015), a measure of diet quality used to assess how well a set of foods aligns with key recommendations. A frailty index (FI) based on accumulation of deficits was developed and comprised 33 variables, including clinical, functional, and cognitive measures. A threshold of ≥ 0.26 was used to define frailty. Frail participants at T1 were excluded from the analysis (n=125). Logistic regression models were constructed to assess the association of HEI-2015 with frailty incidence. Inverse probability weighting was used to minimize attrition bias. Results: Among the 479 T2 participants analyzed (mean [SD], age 84 [5] years, 50% women), 225 (46%) were classified as frail. Frail participants were older, less educated, with a lower household income and a higher comorbidity burden at baseline than non-frail subjects. After adjustment for sociodemographic and lifestyle factors, a higher HEI-2015 score was associated with decreased odds of incident frailty [odds ratio, 0.56 (95% CI: (0.35-0.90), for the upper tertile; 0.68, (95% CI: 0.42-1.09), for the middle tertile, compared with the lower tertile ( P for trend = .005). A spline analysis supported a linear decline in frailty with increasing HEI-2015 scores (Figure). Conclusion: In this cohort study of oldest-old participants, improved diet quality was inversely associated with frailty incidence in a dose-dependent manner.

Shared and distinct factors underlying in-hospital mobility of older adults in Israel and Denmark (97/100)

BackgroundLow in-hospital mobility is widely acknowledged as a major risk factor in acquiring hospital-associated disabilities. Various predictors of in-hospital low mobility have been suggested, among them older age, disabling admission diagnosis, poor cognitive and physical functioning, and pre-hospitalization mobility. However, the universalism of the phenomena is not well studied, as similar risk factors to low in-hospital mobility have not been tested.MethodsThe study was a secondary analysis of data on in-hospital mobility that investigated the relationship between in-hospital mobility and a set of similar risk factors in independently mobile prior to hospitalization older adults, hospitalized in acute care settings in Israel (N = 206) and Denmark (N = 113). In Israel, mobility was measured via ActiGraph GT9X and in Denmark by ActivPal3 for up to seven hospital days.ResultsParallel multivariate analyses revealed that a higher level of community mobility prior to hospitalization and higher mobility ability status on admission were common predictors of a higher number of in-hospital steps, whereas the longer length of hospital stay was significantly correlated with a lower number of steps in both samples. The risk of malnutrition on admission was associated with a lower number of steps, but only in the Israeli sample.ConclusionsDespite different assessment methods, older adults’ low in-hospital mobility has similar risk factors in Israel and Denmark. Pre-hospitalization and admission mobility ability are robust and constant risk factors across the two studies. This information can encourage the development of both international standard risk evaluations and tailored country-based approaches.

Translation and Validation of the Motivation to Change Lifestyle and Health Behaviours for Dementia Risk Reduction (MCLHB-DRR) Questionnaire among the General Israeli Population.

The need to promote awareness of dementia prevention is broadly emphasized in Israel. Currently, there is no valid version of a Hebrew questionnaire to assess attitudes and beliefs related to dementia prevention. This study aimed to translate and validate the MCLHB-DRR questionnaire among the general Israeli population. A total sample of 328 participants between the ages of 50-83 years (mean = 58.7, SD = 6.9) were included in this study. Participants completed the online translated MCLHB-DRR questionnaire. Exploratory factor analyses (EFA) and confirmatory factor analyses (CFA) were conducted to assess the questionnaire's validity. Internal consistency was assessed using Cronbach's alpha. The EFA analysis revealed a seven-factor model with 27 items. One item related to perceived barriers and two items related to perceived severity were deleted. The CFA analysis confirmed a good model fit with the deleted items (χ2/df = 2.146, CFI = 0.930, TLI = 0.916, RMSEA = 0.049). Cronbach's alpha values ranged from 0.61 to 0.92. The Hebrew MCLHB-DRR questionnaire is a valid and reliable measurement tool for assessing attitudes and beliefs related to health behaviours and lifestyle changes for dementia risk reduction in Israeli adults over the age of 50.

Particulate Air Pollution Exposure and Stroke among Adults in Israel.

Stroke is the second most common cause of death and disability in the world. Many studies have found fine particulate matter (PM2.5) exposure to be associated with an increased risk of atherosclerotic cardiovascular disease, mostly focusing on ischemic heart disease and acute myocardial infarction. In a national analysis conducted in Israel-an area with unique climate conditions and high air pollution levels, we estimated the association between short-term PM2.5 exposure and ischemic stroke, intracerebral hemorrhage (ICH), or transient ischemic attacks (TIA). Using the Israeli National Stroke Registry, we obtained information on all stroke cases across Israel in 2014-2018. We obtained daily PM2.5 exposures from spatiotemporally resolved exposure models. We restricted the analytical data to days in which PM2.5 levels did not exceed the Israeli 24 h standard (37.5 µg/m3). We repeated the analysis with a stratification by sociodemographic characteristics and comorbidities. For all outcomes, the exposure-response curves were nonlinear. PM2.5 exposure was associated with a higher ischemic stroke risk, with larger effect estimates at higher exposure levels. Although nonsignificant, the exposure-response curve for TIA was similar. The associations with ICH were nonsignificant throughout the PM2.5 exposure distribution. The associations with ischemic stroke/TIA were larger among women, non-Jewish individuals, older adults, and individuals with diabetes, hypertension, and ischemic heart disease. In conclusion, short-term PM2.5 exposure is associated with a higher risk for ischemic stroke and possibly TIA, even when PM2.5 concentrations do not exceed the Israeli air quality guideline threshold. Vulnerability to the air pollution effects differed by age, sex, ethnicity, and comorbidities.

Monkeypox infection elicits strong antibody and B cell response against A35R and H3L antigens

Monkeypox virus (MPXV) resides in two forms; mature and enveloped, and depending on it, distinct proteins are displayed on the viral surface. Here, we expressed two MPXV antigens from the mature, and one from the enveloped form, and tested their reactivity to sera of 11 MPXV recoverees while comparing to sera from recently and past vaccinated individuals. 8 out of 11 recoverees exhibited detectable neutralization levels against Vaccinia Lister. Sera from all recoverees bound strongly to A35R and H3L antigens. Moreover, the responses to A35R were significantly higher within the recoverees compared to both recently and past vaccinated donors. Lastly, A35R- and H3L-specific IgG+ B cells ranging from 0.03-0.46% and 0.11-0.36%, respectively, were detected in all recoverees (A35R), and in 9 out of 11 recoverees (H3L). Therefore, A35R and H3L represent MPXV immune targets and could be used in a heat-inactivated serological ELISA for the identification of recent MPXV infection.

Intimate partner violence in the shadow of COVID-19 and its associations with stress, function and support among the Israeli general population.

The current study aimed to explore the associations between intimate partner violence (IPV), psychological distress, health and financial concerns, function and support during the COVID-19 outbreak in Israel. Data were collected from 333 Israeli adults (50.8% men and 49.2% women) via an online survey during the third lockdown in Israel. Existing scales were adapted to measure psychological distress, function, and support. Chi-square tests, t-tests, Chi-square tests Z ratios, multiple regressions and a series of process models were employed to examine the research hypotheses. The main findings show that IPV, especially verbal violence, was directly associated with higher levels of distress and lower levels of functioning, a link that could be indirectly mitigated by health and financial concerns as well as lack of family and community support. In addition, low rates of physical violence, with no gender differences and with higher levels of verbal violence reported by women, were found. Finally, women reported higher levels of concerns and psychological distress and lower levels of functioning than men. The results might help identify the needs of families and couples in order to design counselling or training programs for stress and conflict reduction. In addition, the response to the pandemic cannot be a homogeneous response. Different assistive measures must be applied to various segments of the population and groups that are already at risk and, therefore, remain more vulnerable, with targeted assistance given to all of these different groups.

Pandemic-Related Life Events and Physical Inactivity During COVID-19 Among Israeli Adults: The Smoking and Lifestyles in Israel Study.

Public health measures to contain the COVID-19 pandemic have led to disruptions in daily life, such as job loss and changes in activity. The present study examines the relationship between pandemic-related life events and disuse (prolonged sitting coupled with inactivity) among adults. A cross-sectional study of 4084 adults in Israel (September 2020). The primary independent variables were pandemic-related life events, such as job loss. The primary dependent variable was disuse as measured by the Rapid Assessment Disuse Index (RADI). The RADI was examined continuously and dichotomously as a low RADI score (<26: yes/no). Linear regression indicated that experiencing a major life event during the pandemic was associated with lower RADI scores (-1.04; 95% confidence interval, -1.48 to -0.61). Similarly, logistic regression revealed that those experiencing a major life event had 1.18 (95% confidence interval, 1.03 to 1.34) times greater odds for low RADI scores in comparison to those not experiencing an event. Experiencing pandemic-related major life events was linked to less sitting time and increased activity levels among Israeli adults. Future research should examine underlying mechanisms explaining this relationship to facilitate the design and implementation of targeted interventions.

Pilot validation of a verbal practical judgement assessment (VPJ) among community-dwelling older adults in Israel: the first step toward a national standard.

This pilot study aimed to translate, culturally adapt, and initiate the validation of the Hebrew version of the verbal practical judgement (VPJ) assessment among community-dwelling older people. A total of 50 older adults, aged over 65 years, living in the community in Israel, half of whom were independent (n=27, 54%), and the rest dependent participants in a day centre with some level of cognitive/functional decline, completed the VPJ evaluation and comparison assessments. Positive and significant (p<0.05) relationships between VPJ and standard assessments were found, demonstrating convergent validity. By comparing VPJ scores between independent and dependent older adults, results also supported discriminant validity. Finally, a multiple hierarchical regression demonstrated a positive relationship between instrumental activities of daily living and judgement. This pilot study found the VPJ feasible, likely valid, and culturally adaptable to assess judgement in Israeli older adults. Assessing judgement will provide older adults and their families with essential information regarding function, cognition, and safety and will enable them to live/return home in accordance with their autonomy, safety, and well-being.

Inequality in psychological distress among young adults: An integrative model of economic, social, and environmental determinants.

Differences in economic, social, and environmental circumstances lead to systematic and unfair health inequalities. Yet, this inequality is modifiable. Drawing on the social determinants approach to health this study explored: (a) the association between economic, social-relational, and environmental stressors with psychological distress (PD) among a representative sample of young adults in Israel (N = 2,407); (b) the collective impact of these multiple stressors on PD and the extent to which the co-occurrence of stressors demonstrated a stepped relationship with PD. Social determinants included subjective poverty, perceived income adequacy, material deprivation indices, social trust, trust in institutions, perceived discrimination, loneliness, and indicators for the quality of the neighborhood environment. Bivariate analysis was used to assess associations between economic, social-relational, and environmental stressors with PD. Hierarchical linear regressions, estimated to predict PD, showed that the social determinants shaped PD in young adulthood, with each stressor domain making a distinct contribution to explaining PD. Subjective poverty, material deprivation, and loneliness were particularly detrimental. Social determinants were additive, constituting cumulative stressors that convey increased risk for young adults' mental well-being. The findings suggest that health inequality can be reduced by directly addressing its social determinants. Although important, improved access to social and mental health services alone is unlikely to relieve the burden of PD and its adverse consequences both for individual suffering and at the national level. Broader and combined policy measures are required to combat poverty and deprivation, discrimination, lack of trust, and loneliness. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Childhood exposure to parental violence, attachment insecurities, and intimate partner violence perpetration among Arab adults in Israel

BackgroundExtensive research supports the existence of a “cycle of violence” that links exposure to parental violence during childhood (i.e., witnessing interparental violence and child maltreatment) with intimate partner violence (IPV) perpetration. However, there is still a need to explore the mechanisms through which early exposure to parental violence may foster IPV perpetration during adulthood. ObjectiveIn this study, we examine the mediating role of attachment insecurities and gender differences in the relationship between exposure to parental violence during childhood and IPV perpetration during adulthood. Method, participants, and settingWe conducted a cross-sectional survey among a representative sample of 604 married Arab adults (M age = 33.5, SD = 6.52; 50.1 % women) in Israel using a self-administered questionnaire. ResultsExposure to physical violence, both as a victim and indirectly as a witness in childhood, was found positively correlated with adulthood IPV perpetration, with effect sizes ranging from weak (f2 = 0.01) to moderate (f2 = 0.15). Further, attachment-related avoidance was found to mediate the association between witnessing interparental physical violence and IPV perpetration. Gender differences were found in this relationship, with a stronger association indicated among male participants than among females. ConclusionExposure to physical violence may be understood as a risk factor for IPV perpetration directly and indirectly through the development of attachment-related avoidance.

Real-world hepatitis B antiviral treatment trends and adherence to practice guidelines: a large cohort study

ABSTRACT Background Epidemiologic data regarding chronic hepatitis B virus infections in Israel is limited as extensive population-based studies have not been performed. Objective This work aimed to evaluate the current characteristics of hepatitis B infection among Israeli adults and evaluate adherence to the European Association for the Study of the Liver practice guidelines for antiviral treatment. Methods Clinical and demographic data of HBsAg-positive patients registered in the Leumit-Health-Service database (one of the four major health maintenance organizations in Israel) between 2000 and 2019 were retrieved. Patients were compared according to eligibility to antiviral treatment and type of nucleos(t)ide analogue (NA) treatment. Results In total, 1216 patients had documented HBsAg positivity (males 58.6%, mean age 40.2 ± 14.2 years), 90.6% of whom were HBeAg negative. Antiviral therapy eligibility was met by 37% of patients, among whom 89% received antiviral therapy. Antiviral therapies include NA with a high barrier to resistance (HBR) (64.5%) and NA with a low barrier to resistance (LBR) (35.5%). Compared to patients who received LBR NA, patients receiving HBR NA had shorter treatment (68.7 ± 50 vs. 161.5 ± 42.6 months, p < .001) and follow-up duration (125 ± 68 vs. 188 ± 48 months, p < .001); at the end of follow-up, ALT levels and APRI score were higher among patients on LBR NA compared to patients on HBR NA. Conclusion Most patients received antiviral treatment according to the international practice guidelines. However, one-third of them were treated with a less potent NA, probably due to their lower cost. These findings should encourage the optimization of HBV care and full compliance with the professional practice guideline recommendations.

Gaming Disorder and Psycho-Emotional Wellbeing among Male University Students and Other Young Adults in Israel

The aim of this cross-sectional study was to examine the impact of gaming and gaming disorder on the wellbeing of Israeli male university students and other adults. Gaming disorder (i.e., persistent, and recurrent gaming activity associated with a lack of control that may be clinically diagnosed) was determined using the Internet Gaming Disorder Scale-Short-Form (IGDS9-SF). Survey participants were recruited from gaming associations, clubs and the gaming community using Facebook. Data were collected in June 2022. A total of 526 males completed the survey (30.9% university students and 69.1% other young adults). Various statistical methods of analysis including regression were used for this study. Significant study group differences revealed university students with more indications of gaming disorder, more burnout, less loneliness, more stimulant (i.e., Ritalin) use, a greater consumption of salt- and/or sugar-loaded foods and lower economic wellbeing. The levels of resilience (i.e., the ability to recover from stress), substance use (e.g., tobacco and alcohol) and weight gain were similar for the two groups. Regression analysis showed gaming disorder as a key predictor of burnout, economic wellbeing and resilience. This study examined only male gamers because of the small number of female respondents. However, additional research is needed about female internet gamers, including their possible exposure to online harassment and sexual degradation. Additionally, additional research should be considered to verify the present study's findings about gamers based on demographic factors and gaming disorder levels. Prevention and treatment intervention measures, including those that can be made available on campus, should be thought about by university administration personnel and student association leaders in consultation with professionals who are experienced in reducing gaming disorder and other harmful behaviors among students.

Impact of FDA endorsement and modified risk versus exposure messaging in IQOS ads: a randomised factorial experiment among US and Israeli adults

BackgroundIQOS was the first heated tobacco product to receive Food and Drug Administration (FDA) authorisation for ‘reduced exposure’ marketing claims, which has been exploited globally.MethodsIn November–December 2021, we conducted a...

Bystanders’ Behavioral Responses to Intimate Partner Violence: The Role of Gender, Culture, and Education

ABSTRACT Neighbors have a proximate position for detecting in-home emergencies and providing critical assistance. This cross-sectional study tested neighbors’ helping behaviors during intimate partner violence emergencies in a sample of 384 Israeli adults. The aim was to identify potential differences in bystander response depending on the identified victim’s gender and the bystander’s gender and sociocultural group affiliation (i.e., liberal egalitarian or conservative traditional). Four hypothetical scenarios were presented to participants in which either a male or female was the identified victim; the IPV was mutual (i.e., both the male and the female parties were victims); or the victim’s gender was unknown to participants. The highest levels of behavioral responses emerged for the case with a female victim of IPV, and the lowest occurred for the case in which only a male experienced violence. Males preferred personal intervention, whereas females preferred calling welfare services or the police. Conservative traditional individuals preferred calling a religious authority significantly more than liberal egalitarian participants. Results highlight the importance of providing professional interventions, enhancing public awareness, and acknowledging specific cultural beliefs and traditions to sensitively address IPV.

Daily stress, family functioning and mental health among Palestinian couples in Israel during COVID-19: A moderated mediation model.

The COVID-19 pandemic created a range of stressors, among them difficulties related to work conditions, financial changes, lack of childcare, and confinement or isolation due to social distancing. Among families and married individuals, these stressors were often expressed in additional daily hassles, with an influence on mental health. This study examined two moderated mediation models based on Bodenmann's systemic-transactional stress model. Specifically, the models tested the hypothesis that intra-dyadic stress mediates the association between extra-dyadic stress and mental health, while two measures of family functioning, cohesion and flexibility, moderate the relationship between extra and intra-dyadic stress. Participants were 480 Palestinian adults in Israel who completed self-report questionnaires. All were in opposite-sex marriages and identified as either cisgender women or cisgender men. The results showed partial mediation patterns supporting both models, indicating that family cohesion and flexibility weakened the mediating effect of intra-dyadic stress on the relationship between extra-dyadic stress and mental health. These findings increase our understanding of the variables that affected mental health during the pandemic, and suggest that when faced with extra-dyadic stress, married individuals with good family environments are less likely to experience high levels of intra-dyadic stress, which is in turn associated with preserved mental health. Limitations and implications for planning interventions for couples and families during the pandemic are discussed.

Adapting and testing a tool to map digital health resources use by older adults in Israel and Taiwan

Abstract Background Despite the potential of digital health tools for improving health outcomes, older adults are known to use digital health tools differently than younger adults. Focusing on needs of older populations is critical, as their numbers and proportions are projected to increase dramatically in the coming decades, both in Israel and in Taiwan. A bi-national collaboration was developed to map existing digital health resources available to older adults, as part of a larger study on digital health services use among older adults. Methods A mapping tool was adapted from the WHO classification of digital health interventions, based on the experience in the Taiwanese and Israeli health systems. The areas included public health, prevention, self- monitoring and self-care information and services in primary and tertiary care. The mapping documented digital resources offered by governmental/Ministry of Health, public primary care (HMOs), hospitals, and non-governmental organizations. Sources of information were institutional websites, evaluated by two specially trained reviewers for each organization who assigned a dichotomous value (yes/no) for each category. Interrater reliability was computed using a Kappa coefficient. Results The instrument included 17 categories and 44 sub-categories of digital resources, ranging from public health information for emergency situations to specific health service characteristics. To date, the Kappa coefficients range from 0.59-0.68 for NGO, MOH and hospital resources, considered substantial; for 3 HMOs, the values ranged from 0.41-0.49, considered moderate. Conclusions The mapping tool adapted to the countries’ digital resources allowed for bi-national research to compare/contrast the countries’ experience. The next stage of the study will validate the results through expert interviews, followed by an end user survey with older adults to assess both reported use of services and enabling digital health literacy skills. Key messages • To meet the needs of aging populations, attention needs to be given to their engagement with digital health services and resources. • Mapping digital health resources is essential for estimating how health needs are met nationally.

Covid-19-related health literacy: a cross-sectional study in Israel

Abstract Background The “infodemic” related to Covid-19 emphasized the importance of the public’s ability to access, understand, appraise and use information to make decisions about health. This study aimed to: 1. Assess the components of Covid-19 related health literacy (Co-HL) 2. Examine the associations of socio-demographic variables and health status with Co-HL Methods This study was conducted as part of the European Health Literacy Population Survey 2019-2021 (HLS19). A cross-sectional survey of a representative sample of adults in Israel was conducted in December 2020 using phone interviews and an online survey (n = 1,315). Five items measuring Co-HL were added. Multivariable regression models were used to assess the associations between socio-demographic variables and health status with Co-HL. Results Of participants, 63% reported concern about Covid-19. The mean general HL was lower among those who reported concern about Covid-19 compared to those who worried less (p = 0.002). The most difficult component of Co-HL was “judging the reliability of information regarding Covid-19” (36% expressed difficulty). Older participants, those with low self-reported social status, and low self-assessed health, were significantly (p &amp;lt; 0.05) more likely to express difficulty in judging the reliability of Covid-19 information. Interestingly, education level was not significantly associated with Co-HL. Conclusions Our results suggest that, to best promote the use of information on Covid-19 prevention, older people, those with low social status and those with poor general health should be prioritized for improving critical health literacy. Key messages • Co-HL is unequally distributed in the population, warranting tailored health promotion efforts. • It is vital to improve the ability of the population to identify reliable information about covid-19.

Familial Hypercholesterolemia Among Young Adults With Acute Coronary Syndrome

There are limited data on the prevalence and treatment of familial hypercholesterolemia (FH) among Israeli adults who experience premature acute coronary syndrome (ACS). This study aimed to assess the prevalence of FH among young Israeli adults with ACS, examine the rates of lipid-lowering therapy administration, and determine low-density lipoprotein-cholesterol (LDL-C) levels 1 year after ACS. Patients aged ≤55years hospitalized for ACS at Meir Medical Center between 2018 and 2019 were included. Probable/definite FH was defined using the Dutch Lipid Clinic criteria. Outcomes included the proportion of patients with probable or definite FH, rate of use of lipid-lowering medications, LDL-C levels 1 year postadmission, and major adverse cardiovascular and cerebrovascular events during 30months of follow-up. The study population comprised 687 young adults with a median age of 48.5years. Definite/probable FH was present in 61 patients (8.9%). At 1year of follow-up, the proportions of patients without FH who had LDL-C levels <70 and <55mg/100ml were higher than those of patients with FH (55.9% vs 18%, p <0.001 and 35.8% vs 11.5%, p <0.001, respectively). At 1 year of follow-up, only 47.5% and 22% of patients with FH were treated with ezetimibe and proprotein convertase subtilisin/kexin type 9 inhibitor than were those without FH. The incidence of major adverse cardiovascular and cerebrovascular events was significantly higher among patients with FH. In conclusion, clinically defined FH was present in nearly 1 of 11 patients with premature ACS. There is a necessity for more aggressive lipid-lowering therapies in patients with FH after experiencing ACS.

Estimated Infection and Vaccine Induced SARS-CoV-2 Seroprevalence in Israel among Adults, January 2020-July 2021.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) emerged in Israel in February 2020 and spread from then. In December 2020, the FDA approved an emergency use authorization of the Pfizer-BioNTech vaccine, and on 20 December, an immunization campaign began among adults in Israel. We characterized seropositivity for IgG anti-spike antibodies against SARS-CoV-2 between January 2020 and July 2021, before and after the introduction of the vaccine in Israel among adults. We tested 9520 serum samples, collected between January 2020 and July 2021. Between January and August 2020, seropositivity rates were lower than 5.0%; this rate increased from September 2020 (6.3%) to April 2021 (84.9%) and reached 79.1% in July 2021. Between January and December 2020, low socio-economic rank was an independent, significant correlate for seropositivity. Between January and July 2021, the 40.00–64.99-year-old age group, Jews and others, and residents of the Northern district were significantly more likely to be seropositive. Our findings indicate a slow, non-significant increase in the seropositivity rate to SARS-CoV-2 between January and December 2020. Following the introduction of the Pfizer-BioNTech vaccine in Israel, a significant increase in seropositivity was observed from January until April 2021, with stable rates thereafter, up to July 2021.

Perceived stress during COVID-19: Community resilience three years before the pandemic as a protective factor

Research indicates that stress increased across the globe after the outbreak of the COVID-19 pandemic. Community resilience has been suggested as a central protective factor for stress related to disasters and emergency crises. This study examined the contribution of community resilience reported three years prior to the onset of the COVID-19 pandemic, together with related worries and personal risk factors, to perceived stress among Israeli adults following the first wave of COVID-19 in Israel. We performed a two-period 3-year longitudinal study (Period 1 [P1]: July–September 2017; Period 2: [P2] May–June 2020). The final sample included 578 participants. Participants completed a community resilience self-report questionnaire during P1 as well as measures regarding perceived stress and COVID-19 worries during P2. Using linear hierarchical regression, we tested the additional explanatory effect of community resilience and found it to be negatively associated with perceived stress. While health-related worries were not significantly associated with perceived stress, worries related to the functioning of governmental and health institutions regarding the COVID-19 pandemic were significantly associated with perceived stress. Additionally, being single, living in a smaller residence and income reduction during the pandemic predicted higher perceived stress. The current study highlights the potential buffering role of community resilience in protecting against COVID-19 stress. Assessing community resilience may help identify vulnerable groups, and focusing on community building may be an effective strategy to mitigate stress in future disasters.