Jewish Participants Research Articles

A multi-variable model for explaining long-term commitment to volunteering among COVID-19 volunteers.

The aim of the study was to test variables that explain long‐term commitment to volunteering among volunteers in the first wave of the COVID‐19 pandemic in Israel. Long‐term commitment to volunteering was tested by the participants’ evaluation of the stability, consistency, and intensity of their volunteering over time. Two theoretical frameworks served for explaining commitment to volunteering: the social‐structural approach and the psychological characteristics approach. The sample was comprised of 504 Jewish participants: 173 men and 331 women. The data were collected via structured questionnaires distributed by nonprofit volunteer organizations. The most significant contribution to explaining long‐term commitment to volunteering, in all its forms, was for psychological characteristics reflected in emotions during the pandemic and in the motives for volunteering, the volunteer's gender, level of education, and tendency to volunteer during routine times. Volunteer organizations should focus on cultivating a large and motivated population of volunteers to maintain long‐term volunteering during emergencies and in routine times.

The Need to Adjust the Informed Consent for Jewish Patients for Treatments Involving Porcine Medical Constituents.

In order to obtain full informed consent for medical treatments, it is imperative to provide patients of diverse ethnic backgrounds with all relevant information. Since the pig is considered an impure animal in Judaism, Jewish patients may wish to be informed of porcine-derived substances used in treating. The present study is the first to explore the level of knowledge of Jewish participants as to whether the medical use of pig is permitted by their religion, and the extent to which they believe it should be permitted. 714 Jewish participants completed a study questionnaire that included 15 medical uses of pigs. Findings indicated that the knowledge of Jewish law regarding these uses is a significant mediator in predicting the attitude toward the permissibility of these uses. I conclude with practical recommendations as to how to enhance cultural competence and improve the informed consent process when treating Jewish patients with porcine-derived constituents.

Effectiveness of Online Learning Among Graduate Students: Comparison Between Cultures

<p style="text-align:justify">The research aimed to examine students' attitudes towards learning and teaching processes in an online course, investigating whether there was a difference between Jewish and Arab students' attitudes towards this course. The study combined mixed methods. Data were drawn from a questionnaire (including mostly closed-ended questions) completed by 195 graduate students and eight semi- structured interviews. Additionally, the students' grades for their course assignments were analyzed. Findings indicated that all course participants perceived the teaching and learning processes positively, but Jewish students held stronger positive attitudes concerning the learning processes' effectiveness than did Arab students. Jewish course participants' achievements were higher than those of Arab participants. The variable `sector` had a moderating effect on perceptions of the course structure's clarity and success in the course, strong clarity led to Arab students' success on the course but not for Jewish students. Arab students shared their difficulty adapting to a learning style necessitating autonomous learning processes. These findings are explained by Arab society's unique cultural dimensions, characterised by high-power distance and strong avoidance of uncertainty. The findings can inform designers of multicultural online courses that optimal teaching practices necessitate culture sensitivity, and this constitutes an issue for future studies.</p>

COVID-19 Vaccinations and Anxiety in Middle-Aged and Older Jews and Arabs in Israel: The Moderating Roles of Ethnicity and Subjective Age.

Subjective age (i.e., feeling younger/older than one’s chronological age) plays a significant role in older minority group members’ psychological well-being. In light of the importance of vaccinations for fighting COVID-19, it is unclear whether ethnicity and subjective age moderate the connection between receiving COVID-19 vaccinations and anxiety in Israel. Jewish (n = 198) and Arab older adults (n = 84) provided information regarding COVID-19 vaccinations, subjective age, and anxiety symptoms, as well as additional socio-demographic and COVID-19-related health factors (age range= 40–100, M = 62.5, SD = 12.34). Results demonstrated that feeling older was associated with increased anxiety (p < .001) and that vaccinations were linked to increased anxiety among Jews (p < .05). Moreover, the association between COVID-19 vaccinations and anxiety was significant only among Jewish participants with an older subjective age (p < .05). We stress the importance of examining cultural diversities regarding the contribution of subjective age in the context of COVID-19 and psychological well-being.

The Impact of CYP2C9*11 Allelic Variant on the Pharmacokinetics of Phenytoin and (S)-Warfarin.

Cytochrome P450 2C9 (CYP2C9) is responsible for the oxidative metabolism of about 15% of commonly used drugs, some of which are characterized by a narrow therapeutic window. CYP2C9 is highly polymorphic, and over 60 alleles have been described. CYP2C9*2 and CYP2C9*3 are the most common polymorphisms among White patients and both are associated with decreased activity. The evidence concerning the functional importance of less frequent variant alleles is scarce. The objective of the current study was to characterize the in vivo activity of CYP2C9 among carriers of CYP2C9*11, one of the "African" alleles and the fourth most common CYP2C9 variant allele among White patients by using two prototype substrates, phenytoin and (S)‐warfarin. Single 300‐mg phenytoin and 20‐mg warfarin doses were given to 150 healthy Ethiopian Jewish participants who were nonsmokers, at least one week apart. (S)‐warfarin oral clearance and phenytoin metabolic ratio (PMR) derived from the ratio of 5‐(4‐hydroxyphenyl)‐5‐phenylhydantoin in 24‐hour urine collection to plasma phenytoin 12 hours (PMR 24/12) or 24 hours (PMR 24/24) post dosing, were used as markers of CYP2C9 activity. PMR 24/12 and PMR 24/24 were reduced by 50% and 62.2%, respectively, among carriers of CYP2C9*1/*11 (n = 13) as compared with carriers of CYP2C9*1/*1 (n = 127) (false discovery rate (FDR) q < 0.001). The respective decrease in (S)‐warfarin oral clearance was 52.6% (FDR q < 0.001). In conclusion, the enzyme encoded by CYP2C9*11 is characterized by a more than 50% decrease in the enzymatic activity, resembling the extent of decrease associated with CYP2C9*3 ("no‐function allele"). Among patients of African ancestry, CYP2C9*11 genetic analysis should be considered prior to prescribing of narrow therapeutic window drugs such as phenytoin, warfarin, nonsteroidal anti‐inflammatory drugs, or siponimod.

Attitudes and interest in incorporating BRCA1/2 cancer susceptibility testing into reproductive carrier screening for Ashkenazi Jewish men and women.

Pathogenic variants in the BRCA1 and BRCA2 (BRCA1/2) genes are associated with elevated cancer risks in men and women. Due to a founder effect, Ashkenazi Jewish individuals are at higher risk for carrying three specific BRCA1/2 pathogenic variants. There have been recent calls for population screening in this population because many carriers do not have family histories suggestive of hereditary cancer. One approach could be to integrate optional BRCA1/2 testing into routinely offered reproductive carrier screening for recessive and X-linked disorders. However, the differing goals of these types of testing (i.e., personal health risks versus family planning) raise questions about the implications for patient education and informed consent. To this end, we aimed to determine interest, attitudes, and preferences regarding integrating such testing by electronically surveying 331 Ashkenazi Jewish participants in JScreen — a national, not-for-profit, at-home carrier screening program focused on genetic risks in Jewish communities. We found that while 41% of participants had plans to pursue BRCA1/2 testing, 93% would have opted for such testing if offered as an add-on to reproductive carrier screening. This was particularly true of those with higher perceived cancer risk and more positive attitudes toward genetic testing. With respect to preferences about delivery of this service, more than 85% of participants preferred remote (telephone, print, or web-based) genetic education rather than traditional genetic counseling. These results suggest that offering optional BRCA1/2 testing within the context of reproductive carrier screening might provide opportunities for cancer prevention without overburdening scarce genetic counseling resources.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12687-022-00590-3.

Influenza virus vaccine compliance among pregnant women during the COVID-19 pandemic (pre-vaccine era) in Israel and future intention to uptake BNT162b2 mRNA COVID-19 vaccine

The influenza virus vaccine, used worldwide as an annual preventive measure, is especially recommended for at-risk populations. Older adults and pregnant women are therefore offered the flu shot free of charge in Israel. The Israel Ministry of Health’s rationale for giving the influenza vaccine to pregnant women is to avoid serious complications that could harm both mother and foetus. In Israel, the winter of 2020/2021 was marked by a third surge of COVID-19, raising the risk of contracting the SARS-CoV-2 virus and the level of fear among the population. The influenza vaccine protects individuals from the flu and thus helps prevent an additional burden on medical centres treating COVID-19 patients. The aim of the present study was to assess compliance of pregnant and postpartum women to influenza vaccine uptake during winter 20/21 period. A survey questionnaire was distributed to examine factors predicting women’s attitudes toward the influenza vaccine. Questionnaire items based on the Heath Belief Model examined participants’ perceptions regarding influenza and the vaccine. The questionnaire also evaluated participants’ hypothetical willingness to get immunized with the Pfizer COVID-19 vaccine upon its arrival in Israel. The results showed a higher prevalence of influenza vaccine uptake among Jewish women than Arab women, while level of trust in healthcare providers was stronger among Arab participants than among Jewish participants. The findings indicate that the pregnant and postpartum community needs better information dissemination and education regarding the importance of the influenza vaccine. Decisions regarding uptake of the COVID-19 vaccine upon future availability were found to be unrelated to influenza vaccine perceptions. The results call for raising public awareness regarding influenza immunization in addition to offering the vaccine at routine pregnancy follow-up appointments.

Differences in attitudes toward terrorists: Type of terrorist act, terrorist ethnicity, and observer gender and cultural background

To explore the interrelationship between terrorist acts, terrorist ethnicity, and observer gender and cultural background in Israel, we recruited 211 participants aged 19–75 years. The majority were male (63%). As for the ethnic and religious cultural background, 40% were Jewish, 40% Druze, and 20% Muslim. The participants answered questions about their demographic characteristics, read three scenarios of terrorist acts, addressed attitudes toward terrorists, and suggested the length of imprisonment. We manipulated the type of act (shooting and killing/burning religious institutions/throwing stones at cars) and terrorist ethnicity (Arab/ Jewish). The results indicate significant main effects of the manipulated variables regarding attitudes toward terrorists. Also, Muslim Arab participants expressed more negative attitudes in cases of Jewish terrorists than Arab terrorists, whereas Jewish participants expressed more negative attitudes toward Arab terrorists than Jewish terrorists. Druze participants did not differentiate between Arab and Jewish terrorists. Furthermore, in cases of Arab perpetrators, Jewish participants suggested imprisonment terms 2.4 times longer than in cases of Jewish perpetrators. The discussion addresses the findings in the context of social identity theory and dual social identification. Regarding practical implications, the findings imply the need for education and training on ethnic bias among policymakers and practitioners.

“Under the Radar”: How is the Jewish–Arab Conflict Reflected in Internal Jewish Dialogue?

This study explores the role of intergroup conflict in the identity exploration process among 83 Jewish participants in a dialogue in a multicultural college in Israel. Thematic analysis has shown that the behavior of most of the participants has been affected by the Jewish&amp;ndash;Arab conflict as follows: they centered on internal commonalities among Jewish subgroups; they neither engaged in conflict among Jewish subgroups nor explored their Jewish identities, and they expressed confusion regarding who the out-group was: the Jewish subgroups&amp;rsquo; members or the Arab students in the college. These findings expand the knowledge about the identity exploration process in a social context of religious&amp;ndash;ethnic conflict and may pose a practical contribution to the field of intergroup dialogues and conflict resolution in divided societies.&amp;nbsp;&#x0D; &amp;nbsp;

The Relationship between Type 2 Diabetes, Differentiation of Self, and Emotional Distress: Jews and Arabs in Israel.

Type 2 diabetes mellitus (T2DM) is considered a global epidemic, and is constantly on the rise. In Israel, the percentage of diabetics in the Arab population is twice that found in the Jewish population (12% and 6.2%, respectively). Findings suggest that low differentiation of self (DoS: emotional reactivity+ fusion with others, I-position, emotional cutoff) may raise vulnerability to certain physiological pathologies by increasing susceptibility to psychological distress. The major goal of this study was to test differences in DoS and emotional distress (anxiety and depressive symptoms) between diabetic and healthy participants. The second aim was to examine cultural differences within these metrics. Another purpose was to examine the relationship between DoS and emotional distress among healthy and diabetic participants. The sample included 261 participants, of whom 154 were healthy and 107 were diabetic. Diabetics reported more severe depressive symptoms, higher levels of anxiety and emotional cutoff and lower levels of I-position than healthy individuals. The groups did not differ in their levels of emotional reactivity + fusion with others. Arabs demonstrated higher levels of emotional cutoff, anxiety and depressive symptoms and lower levels of I-position than Jews. However, Arabs and Jews did not differ in their levels of emotional reactivity + fusion with others. Emotional reactivity + fusion with others contributed the most to diabetes among Arabs, while depressive symptoms contributed the most among Jews. Finally, among Jewish participants, age was positively correlated with emotional cutoff and depressive symptoms. Emotional cutoff was positively correlated with anxiety and depressive symptoms. Emotional reactivity + fusion with others was positively correlated with anxiety. Among Arab participants, age was positively correlated with emotional cutoff, anxiety and depressive symptoms. I-position was negatively correlated with all study variables. Emotional cutoff was positively correlated, anxiety and depressive symptoms. Emotional reactivity + fusion with others was positively correlated with anxiety and depressive symptoms.

Prevalence and correlates of forgone care among adult Israeli Jews: A survey conducted during the COVID-19 outbreak.

Efforts to control the spread of the novel Coronavirus (COVID-19) pandemic include drastic measures such as isolation, social distancing, and lockdown. These restrictions are accompanied by serious adverse consequences such as forgoing of healthcare. The study aimed to assess the prevalence and correlates of forgone care for a variety of healthcare services during a two-month COVID-19 lockdown, using Andersen’s Behavioral Model of Healthcare Utilization. A cross-sectional study using computerized phone interviews was conducted with 302 Israeli Jewish participants aged 40 and above. Almost half of the participants (49%) reported a delay in seeking help for at least one needed healthcare service during the COVID-19 lockdown period. Among the predisposing factors, we found that participants aged 60+, being more religious, and reporting higher levels of COVID-19 fear were more likely to report forgone care than younger, less religious and less concerned participants. Among need factors, a statistically significant association was found with a reported diagnosis of diabetes, with participants with the disease having a considerably higher likelihood of forgone care. The findings stress the importance of developing interventions aimed at mitigating the phenomenon of forgoing care while creating nonconventional ways of consuming healthcare services. In the short term, healthcare services need to adapt to the social distancing and isolation measures required to stanch the epidemic. In the long term, policymakers should consider alternative ways of delivering healthcare services to the public regularly and during crisis without losing sight of their budgetary consequences. They must recognize the possibility of having to align medical staff to the changing demand for healthcare services under conditions of health uncertainty.

Ageism towards older and younger people in the wake of the COVID-19 outbreak

ObjectivesThe COVID-19 pandemic has provided a rich environment for ageist attitudes towards both older and younger people. However, publications on ageism during the outbreak have been mostly non-empirical and have concentrated on ageist beliefs directed towards older people. To overcome these limitations, we examined empirically the prevalence and the determinants of ageism towards older and younger people in the wake of COVID-19. Study designA cross-sectional study using an online survey was conducted with 503 Israeli adults (51.9% male, 79.5% Jews, mean age 47 years). Main measuresWe used a structured questionnaire that measured the following: COVID-19 ageism towards older people, COVID-19 ageism towards younger people, stereotyping, the experience of discrimination, perceived fears about contracting COVID-19, subjective knowledge about COVID-19, and sociodemographic characteristics. ResultsOverall, participants reported a relatively low level of COVID-19 ageism towards older people but a significantly higher level of COVID-19 ageism towards younger people. Hierarchical regressions revealed that negative age stereotypes were the most important determinants of both types of ageism. Sociodemographic variables (including age and majority/minority) were significant determinants only for COVID-19 ageism towards older people. That is, older and Jewish participants reported lower levels of this type of ageism. ConclusionsOur findings demonstrate that negative age-related stereotypes have played a central role in ageist beliefs towards both older and younger people during the COVID-19 crisis. It is recommended that the public and scientific media start disseminating messages aimed at reducing rather than increasing negative stereotypes directed towards younger and older people.

Trust the directives and physical distancing during three COVID-19 lockdowns in Israel

The emergence of the COVID-19 virus highlighted the importance of public trust in official directives during a pandemic. As part of the measures taken to reduce the spread of the coronavirus, people were asked to maintain physical distancing. Compliance with physical distancing influenced by trust levels which are generally lower in minority groups. The current study aimed to explore the trust level and compliance with the physical distancing relationship among Arab minority and Jewish populations during three lockdowns during the COVID -19 outbreak in Israel. Three cross-sectional online surveys were conducted among a convenience sample of Jews and Arabs adults (≥18 years old) citizens of Israel following the first (April to June 2020), second (October to November 2020), and third lockdown (January to February 2021). The surveys collected demographic data, compliance with physical distancing, and trust level in official sources. In total, 613 (N = 281 Arab, N = 281 Jewish) participants completed the first online survey, 542 (N = 223 Arab, N = 319 Jewish) completed the second survey, and 98 (N = 38 Arab, N = 60 Jewish) completed the third survey. In the three surveys, both populations, Arabs and Jews, reported higher levels of trust in health professionals than in politicians. The level of trust and keeping physical distancing during the three lockdowns were significantly lower among Arab compared to the Jewish participants. However, the association between trust and social distancing was significant only in the first lockdown (OR = 2.02, 95% CI 1.37-2.97) but not in the second and third lockdowns. Trust in official directives is an important determinant of citizens' compliance with physical distancing guidelines during a pandemic. Minority groups have lower trust levels and face more challenges for keeping physical distancing. This should be brought to the policymakers' attention to increase trust and physical distancing among them.Key messages Understanding the relationship between trust and compliance and its potential consequences during a pandemic warrant particular attention in the present context of a global pandemic.It is of utmost importance to identify the unique characteristics of sub-populations and minority populations in which there may be additional factors affecting compliance.

The relationship between family-work conflict and spousal aggression during the COVID-19 pandemic

ABSTRACT The present study investigated the relation between resources and experience of family-work conflict during the COVID-19 pandemic and expressions of spousal aggression. Resources were assessed by relaxed family communication and by flexibility in coping. Spousal aggression was assessed by spousal undermining and adoption of maladaptive tactics for marital conflict management: physical violence, verbal-emotional violence, and avoidant tactics. The research sample included 406 Israeli Jewish participants (206 women and 200 men) who worked from home at least 3 days a week during August 2020 and are parents to young children. Family-work conflict was related to spousal undermining and to adoption of verbal-emotional and avoidant tactics. Spousal undermining mediates the relationship between family-work conflict and maladaptive tactics for marital conflict management. The coping flexibility resource is negatively correlated to spousal undermining and to adoption of physical violence tactics during marital conflict management. No gender differences were found in family-work conflict and in assessment of spousal aggression. Based on the findings, practical recommendations are offered to professionals and policy makers in organizations to reduce the damage of a role conflict experience on the marital relationship.

The Relationships Between Personality Traits and Public Stigma Attached to Families Bereaved Due To Suicide.

Suicide is a serious global public-health issue that is perceived as the most stigmatizing of sudden losses. Most studies on this topic have examined how bereaved families perceive public stigma, paying less attention to the actual stigma experienced by those not directly bereaved. Therefore, this study examined the association between personality traits and the public stigma attached to families that have lost a member to suicide. Three hundred and eighty (N = 380) Israeli participants completed demographic, Big 5, and stigma questionnaires. The study findings demonstrate that neuroticism and openness to experience are associated with higher levels of public stigma, while conscientiousness is associated with lower levels of public stigma. In addition, Arab participants reported higher levels of public stigma than Jewish participants. These findings make an important contribution to our understanding of the relationship between personality traits and the public stigma attached to families that have lost a member to suicide.

Individual and situational predictors of intention to hire gay male and ultra-orthodox male job applicants

PurposeThis paper examines personal and situational factors that may contribute to biases in hiring decisions at the workplace, focusing on willingness to hire male gay or male Jewish ultra-Orthodox Jewish job candidates.Design/methodology/approach942 Jewish participants in Israel responded to an anonymous online questionnaire regarding a scenario addressing the possible employments of two male applicants: a homosexual and an ultra-Orthodox Jew. A variety of statistical tools, including regression analysis were performed to test hypotheses.FindingsFindings show that social dominance orientation, conservatism, gender and religiosity as well as frequency of contact with the “unlike other” impacted on hiring intention of the participants. These relationships varied in strength and direction with regard to the two applicant types in question.Practical implicationsThe explication of the phenomenon in question has both important theoretical and practical importance in a world where – concurrently – there exists increasing contact among individuals from different backgrounds and (perhaps not coincidently) increased signs of wariness of and discrimination toward those unlike ourselves. In light of economic costs related to discrimination – not to mention the personal costs to those discriminated against – organizations must better understand the dynamics of the phenomenon in question.Originality/valueThis is one of the first empirical examinations of the relative impact of personal and situational factors on hiring bias. In addition, it is the first study of its kind in Israel focusing on the mechanisms behind hiring bias toward gay males and ultra-orthodox males.

Factors That Influence Parents’ Decision-Making Regarding Termination of Pregnancy After Prenatal Diagnosis of Fetal Congenital Heart Disease

ObjectiveTo explore factors that influence parents’ decisions regarding the termination of pregnancy after the detection of fetal congenital heart disease (CHD). DesignA prospective descriptive study. SettingThe Institute of Pediatric Cardiology in the Schneider Children’s Medical Center. ParticipantsOne hundred twenty couples (240 participants) with fetuses prenatally diagnosed with CHD, which was defined as conditions requiring surgical treatment. MethodsWe obtained data from a structured questionnaire for the pediatric cardiologist, the medical records, and structured self-report questionnaires for the participants. ResultsThirty-six of 120 couples (30%) decided to terminate the pregnancy after a prenatal diagnosis of fetal CHD. The main factors associated with the decision to terminate were low gestational age (OR = 0.83 per week, 95% confidence interval [CI] [0.75, 0.96]), severe cardiac malformation (OR = 2.23, 95% CI [1.40, 3.53]), religious affiliation (OR = 10.0 for secular participants vs. others, 95% CI [4.61, 22.46], population group (OR = 2.96 for Jewish participants vs. others, 95% CI [1.63, 11.3]), and education (OR = 1.34 per year of education, 95% CI [1.15, 1.55]). ConclusionsOur findings describe the profiles of couples who decided to terminate their pregnancies after a prenatal diagnosis of fetal CHD. Early identification of the couple’s decision can help health care providers provide adequate support, counseling, and guidance. Future research is needed to understand parents’ needs for support through the process of decision-making, with attention to their religious and cultural values and contexts.

Effect of longevity genetic variants on the molecular aging rate.

We conducted a genome-wide association study of 1320 centenarians from the New England Centenarian Study (median age = 104 years) and 2899 unrelated controls using >9 M genetic variants imputed to the HRC panel of ~65,000 haplotypes. The genetic variants with the most significant associations were correlated to 4131 proteins that were profiled in the serum of a subset of 224 study participants using a SOMAscan array. The genetic associations were replicated in a genome-wide association study of 480 centenarians and ~800 controls of Ashkenazi Jewish descent. The proteomic associations were replicated in a proteomic scan of approximately 1000 Ashkenazi Jewish participants from a third cohort. The analysis replicated a protein signature associated with APOE genotypes and confirmed strong overexpression of BIRC2 (p < 5E-16) and under-expression of APOB in carriers of the APOE2 allele (p < 0.05). The analysis also discovered and replicated associations between longevity variants and slower changes of protein biomarkers of aging, including a novel protein signature of rs2184061 (CDKN2A/CDKN2B in chromosome 9) that suggests a genetic regulation of GDF15. The analyses showed that longevity variants correlate with proteome signatures that could be manipulated to discover healthy-aging targets.

Cultural generativity in perspective: motivations of older Jewish volunteers

AbstractThe physical, mental and social benefits for older adults who volunteer are well-documented. Absent from this area of research is an understanding of volunteer motivations among ethnoculturally diverse older adults. This paper addresses this research gap by examining motivations to volunteer related to cultural generativity among Jewish older adults, a group that remains underexplored in research. Cultural generativity is defined as an impulse to pass down one's culture to the next generation, and thus to outlive the self. The Jewish community is notable for possessing high levels of social capital, indicated by close community ties and the large number of faith and culturally based organisations, and therefore makes them an important ethnocultural group to study. Semi-structured qualitative interviews were conducted with 20 adult volunteers age 65 and over. The guiding research questions for this study are: What are the motivations to volunteer among older Jewish adults? and Do these motivations align with the concept of generativity applied to Jewish culture? Data analysis identified three themes related to cultural generativity: volunteering to preserve and pass down Jewish traditions and teachings; a Jewish ethic of giving back perceived as a duty; and experiences of anti-Semitism and discrimination motivating Jewish participants to volunteer. Findings suggest the ways in which cultural generativity may be expressed through volunteerism.

Associations of psychosocial factors, knowledge, attitudes and practices with hospitalizations in internal medicine divisions in different population groups in Israel

BackgroundInequalities in healthcare utilization exist across ethnic groups; however, the contributions of health-related knowledge and psychosocial factors to these inequalities remain unclear. We examined associations of social determinants of health, psychological factors, knowledge, attitudes and health practices, with hospitalizations in internal medicine divisions, among Israeli adults, Jews and Arabs, with non-communicable diseases, in a setting of universal health insurance.MethodsA retrospective study was undertaken among 520 Jews and Arabs aged 40 years or older with non-communicable diseases, members of a large health maintenance organization. Hospitalization (at least once during 2008) in an internal medicine division was determined based on documentation in electronic health records. Participants were randomly selected in strata of sex, population-group and hospitalization status (yes/no). Data were collected from medical records and via face-to-face interviews using a structured questionnaire. Main independent variables included comorbidity burden, health behaviors, mental health wellbeing and self-rated health. Scales measuring health knowledge and attitudes/beliefs were constructed using factor analysis.ResultsComorbidity burden (OR 1.41 [95% CI 1.24–1.61]) and self-rated health (not good vs. good) (OR 1.88 [95% CI 1.13–3.12]) were positively associated with hospitalizations in an internal medicine division, while an inverse association was found with better mental health wellbeing (OR 0.98 [95% CI 0.96–0.99, for each 1-point score increase). Among Jewish participants, positive associations were found of the number of offspring, comorbidity burden and perceived difficulty, with hospitalizations. No significant associations were found with hospitalizations of other sociodemographics, health behaviors, knowledge and attitudes/beliefs.ConclusionsComorbidity burden was the main risk factor of hospitalizations in internal medicine divisions. Psychosocial factors, such as self-rated health, a complex variable affected by social capital, mental wellbeing, the number of offspring, and perceived burden and difficulty, seem also to contribute. These findings suggest the involvement of broad family and social factors, beyond individual level characteristics and medical needs, in hospitalizations in internal medicine divisions. Interventions to reduce hospitalizations should be comprehensive and integrate aspects of mental health wellbeing; they should build on familial characteristics (e.g., number of offspring), factors related to social capital such as self-rated health, and perceived burden and difficulty.