Palestinian Schoolchildren Research Articles

Cluster Analysis and Classification Model of Nutritional Anemia Associated Risk Factors Among Palestinian Schoolchildren, 2014.

Nutritional inadequacy has been a major health problem worldwide. One of the many health problems that result from it is anemia. Anemia is considered a health concern among all ages, particularly children, as it has been associated with cognitive and developmental delays. Researchers have investigated the association between nutritional deficiencies and anemia through various methods. As novel analytical methods are needed to ascertain the association and reveal indirect ones, we aimed to classify nutritional anemia using the cluster analysis approach. In this study, we included 4,762 students aged between 10 and 17 years attending public and UNRWA schools in the West Bank. Students' 24-h food recall and blood sample data were collected for nutrient intake and hemoglobin analysis. The K-means cluster analysis was used to cluster the hemoglobin levels into two groups. Vitamin B12, folate, and iron intakes were used as the indicators of nutrient intake associated with anemia and were classified as per the Recommended Dietary Allowance (RDA) values. We applied the Classification and Regression Tree (CRT) model for studying the association between hemoglobin clusters and vitamin B12, folate, and iron intakes, sociodemographic variables, and health-related risk factors, accounting for grade and age. Results indicated that 46.4% of the students were classified into the low hemoglobin cluster, and 60.7, 72.5, and 30.3% of vitamin B12, folate, and iron intakes, respectively, were below RDA. The CRT analysis indicated that vitamin B12, iron, and folate intakes are important factors related to anemia in girls associated with age, locality, food consumption patterns, and physical activity levels, while iron and folate intakes were significant factors related to anemia in boys associated with the place of residence and the educational level of their mothers. The deployment of clustering and classification techniques for identifying the association between anemia and nutritional factors might facilitate the development of nutritional anemia prevention and intervention programs that will improve the health and wellbeing of schoolchildren.

Oral Health Status and Oral Health Behaviour among 5- to 6-year-old Palestinian Schoolchildren - Towards Engagement of Parents and Schoolteachers for Oral Health through Schools.

1. To assess the oral health status and health behaviour of 5- to 6-year-oldchildren and the influence of socio-behavioural factors on oral health among children, and 2. evaluate dental knowledge and attitudes related to oral health promotion of children among mothers and schoolteachers in Palestine. This cross-sectional survey was carried out in 2017, and recruited samples of children (n = 3939, 53.8% boys, 44.8% girls) from 61 primary schools, their mothers and schoolteachers (n = 53). Participants were selected randomly by multistage stratified cluster sampling. Calibrated dentists performed oral examinations of 5- to 6-year-old schoolchildren based on WHO criteria. Mothers and teachers completed WHO self-administrated questionnaires to assess children's oral health behaviour, as well as their knowledge and attitudes towards children's dental care. Caries prevalence of primary teeth was 83.4% and caries experience was high (dmf-s = 11.17). One-fourth of children suffered from pain or discomfort from teeth, and 57.7% of children had seen a dentist within the past 12 months, frequently due to pain or problems. Consumption of sugars was frequent and only 19.7% brushed their teeth every day. Neglect of dental visits, infrequent toothbrushing, being a child from families of urban settings and high socioeconomic status were greatly affected by caries. Mothers and schoolteachers had mostly positive attitudes towards school-based oral health care. However, the availability of dental health education materials was extremely low. The establishment of school-based oral health programmes, including effective use of toothpaste containing fluoride for caries prevention, is greatly needed to improve the oral health of Palestinian children. The introduction of fluoridated school milk is highly recommended. The establishement of school programmes should encompass active involvement of schoolteachers and mothers to promote the development of healthy lifestyles and sustainable oral health behaviours among schoolchildren. Provision of materials for health education by schoolteachers and mothers is urgently needed.

Breakfast characteristics, perception, and reasons of skipping among 8th and 9th-grade students at governmental schools, Jenin governance, West Bank

BackgroundThere is growing recognition of the important role of breakfast in children’s nutrition, and the potential harms related to skipping breakfast, including its contribution to obesity and non-communicable diseases. The patterns associated with skipping breakfast may be related to the nutrition transition. This study aimed at exploring the composition of breakfast consumed by Palestinian school children and their perceptions toward this meal. It also aimed at exploring skipping breakfast prevalence, reasons, and its association with selected schoolchildren’s sociodemographic variables and behavioral patterns.MethodsA cross-sectional online survey was conducted among 12- to 14-year-old schoolchildren from 4 governmental schools in urban and rural areas of the Jenin district in Palestine. The questionnaire included information about children and parents sociodemographic and behaviours, breakfast patterns and composition, reasons for skipping breakfast, and items on schoolchildren’s perception toward breakfast. Statistical analysis of the relevant factors was undertaken using SPSS software.ResultsIn a sample of 193 schoolchildren, only 32% reported consuming breakfast all year round. The main reasons reported for skipping breakfast were not feeling hungry, not having the time, and lack of appetite. The vast majority (79%) believed breakfast was beneficial for general health. Sleeping before 10 pm, regular exercise (p value < 0.05). and shorter screen time were all significantly associated with a higher level of breakfast consumption (p value < 0.01).ConclusionUnderstanding the reasons for missing or skipping breakfast factors which make skipping it more likely, should inform public health strategies to promote breakfast consumption. For example, our findings suggest that awareness of the importance of breakfast was not a significant contributor to skipping breakfast, compared to other structural and cultural factors.

Differences in Neuropsychological Performance between Refugee and Non-Refugee Children in Palestine.

Neuropsychological studies on refugee children are scarce, but there are even less in the case of Palestinian children. This work aims to study the neuropsychological performance of Palestinian refugee children in Palestine compared to other Palestinian children living outside refugee camps. A comprehensive Neuropsychological battery was administrated to 584 Palestinian school children (464 refugees and 120 non-refugees) aged 6, 7, and 8 years old. Results showed that non-refugee children outperformed refugee children in sustained attention, verbal comprehension, verbal memory, and visual memory. This study is the first to have performed a comprehensive neuropsychological assessment, based on a standardized and validated battery with the Palestinian refugee children. It supports professionals in their evaluation of neurodevelopment and neuropsychological alterations in refugee and non-refugee children in Palestine.

Micronutrient status of Palestinian school children following salt and flour fortification: a cross-sectional study

BackgroundIn 1996 and in 2006, Palestine initiated salt iodization and multiple micronutrient fortification of wheat flour, respectively as a strategy to prevent deficiencies of these nutrients. In 2009, we assessed the impact of these interventions on the health and nutritional status of schoolchildren residing in the West Bank.MethodsWe surveyed a sample of 22 schools run by the UN Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) and the Palestinian Government. We randomly selected students from the first (mean age 6.7 years [SD 0.5]), sixth (11.8 years [0.6]), and ninth grades (14.8 years [0.6]). Data were obtained from 1484 (99%) of 1500 students planned for enrollment.ResultsOur results suggest that iodine intake appears adequate and there was essentially no iodine deficiency. As to the status of other micronutrients, the main nutritional micronutrient risks for schoolchildren in the West Bank continue to be low serum levels of iron, zinc, and vitamin B-12; folate levels were seemingly high. The overall prevalence of anemia was 9.6%, but there were pockets of anemia in certain districts. Almost 42% of the anemia in our sample was explained by iron deficiency. There were significant differences in iron deficiency between girls and boys, 29.5% vs. 15.7%, respectively (p = 0.0001). There were no cases of lead toxicity in the studied sample.ConclusionsWheat flour and salt fortification has had a major influence on improving the micronutrient status of Palestinian children, for some but not all micronutrients. The recommended key blood and biochemical parameters to be incorporated in the surveillance system are iron, zinc, and vitamin B12.

Obesity-Related Parameters Are Associated with Blood Pressure in Palestinian Children

Hypertension has been established as a common health condition in young people. Most studies have focused on the impact of body mass index (BMI), but the relationships between body composition parameters and blood pressure in Palestinian children has not previously been investigated. We aimed to analyze the prevalence of overweight/obesity and elevated blood pressure/hypertension and investigate the associations among obesity-related parameters, including anthropometric and body composition markers and blood pressure levels in a population of 971 Palestinian school children (50% girls; mean age 10.3 ± 1.1 years). Anthropometric measurements including height, waist circumference (WC), hip circumference (HC), waist-to-hip ratio (WHR), and waist to height ratio (WHtR) were assessed. A body composition analyzer was used to measure body weight, fat mass, and fat-free mass. Blood pressure including systolic (SBP), diastolic (DBP) and mean arterial pressure (MAP) were measured using a Dinamap vital signs monitor. The prevalence of overweight/obesity was 25.3% in the girls and 23.1% in the boys. 26.3% of the children had elevated systolic blood pressure, or systolic hypertension; whereas 23.4% had elevated diastolic blood pressure, or diastolic hypertension. All obesity-related variables, with the exception of WHR and WHtR, showed statistical differences among the normotension, elevated blood pressure and hypertension groups for systolic and diastolic blood pressure (p < 0.05). Children with elevated blood pressure or hypertension had significantly higher weight, BMI, WC, HC, fat mass, and fat-free mass values compared to participants with normotension, supporting the direct association between obesity and hypertension in this population. Weight-reduction interventions are essential for reducing the prevalence of childhood hypertension in Palestinian children.

Pattern of substance use among schoolchildren in Palestine: a cross-sectional study

BackgroundTobacco smoking, alcohol use, and illicit drug use are significant health, psychological, and social problems among youth in Palestine. The aim of this study was to provide insight into the extent and the pattern of psychoactive substance use among schoolchildren in the West Bank in Palestine. A cross-sectional study in 16 schools was conducted in 2016. Eight hundred seventy-seven students of 10th grade were chosen randomly. Modified self-administrated questionnaire from Monitor the Future Study and European school survey project on alcohol and other drugs was used.ResultsThe most current substance used by schoolchildren was tobacco (40.6%), followed by alcohol (3.2%) and illicit drugs (2.0%). Around 59.7, 7.9, and 2.9% of the schoolchildren had tried, at least once in their lifetime, tobacco, alcohol, and illicit drugs, respectively. Moreover, 11.1% of them who had not yet tried a substance intends to smoke tobacco, 1.4% intends to drink alcohol, and 0.3% intends to try illicit drugs. Curiosity and experience was the most frequent motivation for using these substances. The mean age of initiation was 12 years for smoking and 14 years for drinking alcohol or using illicit drugs. Most of the illicit drug users (78.3%) had tried more than one illicit drug or more than one substance at the same time. Cannabis and synthetic cannabinoids followed by amphetamines were the most commonly used drugs. Around 78.8%, 37.6%, and 27.6% agreed that tobacco, alcohol, and illicit drugs, respectively, were easily accessible in their communities. Work was significantly associated with increased risk for substance use across various substances.ConclusionMany factors had determined the danger of using psychoactive substances by Palestinian schoolchildren including the initiation age, the availability, the type of the substances used, and the frequency of the use, and using multiple substances at the same time. Curiosity and experience, peer pressure, families, and working were the most important motives. Health care professionals, clinicians, and ministries of education, health, and labor have key responsibilities in preventing substance use among youth and need to develop more effective prevention and cessation strategies. The Palestinian National Authority needs to make more efforts in smoking legislation regulating the age of access and smoking for youths and adults.

Metabolic Syndrome and its Risk Factors among Overweight and Obese Palestinian Schoolchildren using IDF and NCEP-ATP/III Definitions

Background: Warning signs of metabolic syndrome (MetS) can appear during childhood. Early detection and treatment of MetS is likely to reduce morbidity and mortality in adulthood and help to keep to minimum the global burden of cardiovascular diseases and type II diabetes. This study aimed to establish the prevalence and to characterize metabolic syndrome and its individual components among overweight and obese Palestinian schoolchildren aged 6-<18 years in the West Bank. Methods: A cross sectional study was conducted in the West Bank-Palestine in the year 2014. Out of the 840 schoolchildren, 216 (30.7%) were overweight and obese; 146 of them were evaluated for MetS using the International Diabetes Federation and modified National Cholesterol Education Program-Third Adult Treatment Panel definitions. Results: Using NCEP criteria, MetS was significantly more prevalent in overweight and obese children (23.3%) than IDF (15.8%) and among boys (22.2% for NCEP vs 12.3% for IDF) and girls (23.3% for NCEP vs 20.0% for IDF). No sex-specific differences in the prevalence of MetS between age groups were determined using both criteria. The prevalence of individual MetS components according the IDF and NCEP criteria were respectively; (32% and 25.3%) for increased waist circumference, (15.8% and 37.0%) for increased blood pressure, (9.7% and 24.8%) for increased triglyceride, (57.2% and 55.9%) for low HDL, and (39.7% and 15.8%) for increased fast blood sugar. Clustering of metabolic abnormalities had significantly increased by increasing body mass index and waist circumferences, and with decreased HDL and elevated triglyceride. Conclusions: The prevalence of MetS among overweight and obese Palestinian schoolchildren is high with dyslipidemia being the most common MetS abnormality. Regardless the definition used to diagnose MetS among children; the findings of this study present a serious threat to current and future health of Palestinian children.

“Christian Peacemaker Teams in Israel/Palestine: Beyond Accompaniment”

“Christian Peacemaker Teams in Israel/Palestine: Beyond Accompaniment” Marlaina A. Leppert-Wahl Abstract This article examines and analyzes Christian Peacemaker Teams‘ (CPT) attempt to reduce violence and foster justice in the Israeli-occupied West Bank through third-party nonviolent intervention.Specifically, it examines CPT‘s accompaniment strategies and solidarity activities in support of Palestinians under occupation such as nonviolent resistance, advocacy, and support for the Boycott, Divestment, and Sanctions movement.CPT‘s accompaniment practices have resulted in safer passage for Palestinian school children and protection for farmers, shepherds, and the Palestinian communities threatened by Israeli soldiers and settlers. Other nonviolent direct action in solidarity with Palestinians has supported civil resistance against the Occupation. CPT‘s partisanship in this regard has drawn criticism and hostility from Israelis and others.CPT‘s choice of strategies is driven by its foundation of faith and Christian calling to work in solidarity with the most vulnerable populations. There is certainly a niche for CPT‘s brand of nonviolent intervention in Palestine, but it will not appeal to all organizations interested in protecting marginalized communities with the perception of impartiality. Full Text: PDF DOI: 10.15640/jgpc.v5n2a1

Health Knowledge, Attitudes, Practices, and Beliefs of Lebanese and Palestinian School Children in Lebanon

The indicators for health risk factors among school children in Lebanon associated with increased mortality and morbidity were higher than the global percentage based on WHO (2014) statistics. Knowing that the Ministry of Education in Lebanon has been trying to include health education in the national school curriculum since the last reform in 1997, this qualitative exploratory study analyzed the students’ arguments resulting from focus group discussions to identify their level of knowledge, attitudes and perceptions and to provide suggestions for improving the national textbooks and teaching practices. Data were collected through focus group discussions with grade 5 students in 2 schools: Lebanese public school and UNRWA Palestinian School. The content analysis technique was used to perform the analysis and interpretation of data. Data was coded based on criteria from the Rational Model as well as the Health Belief Model. The study found, among other things, that students in both schools acquired the knowledge present in the textbooks about the benefits of balanced nutrition but they gave inaccurate and incomplete justifications with no scientific reasoning. Regarding attitudes, they show negative attitudes toward prefer unhealthy food over healthy ones. Some of their practices were healthy but unhealthy snacks, skipping breakfast, drinking big amounts of soft drinks were prevalent. The arguments of the students in both schools also showed some social related practices as related to the opinions, behavior, advice, and support of the people surrounding students influence their feelings and behavior, and the students have a reciprocal effect on those people.

Double Burden of Undernutrition and Obesity in Palestinian Schoolchildren: A Cross-Sectional Study.

The coexistence of underweight and overweight (double burden) remains a major problem in many developing countries. Little is known about the factors associated with the double burden of malnutrition in Palestinian children. To assess factors associated with undernutrition and overnutrition in 1500 schoolchildren aged 5 to 16 years, in the West Bank. We surveyed a sample of 22 schools run by the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) and the Palestinian government. Binary logistic regression was used to examine the factors associated with malnutrition. The hunger index, a composite score from 8 questions, was used to measure food insecurity. In the 1484 children enrolled in UNRWA and government schools in the West Bank, the prevalence of stunting was 7% and underweight 3%. Around 12% of students were overweight and 6% obese. The hunger index was negatively associated with height for age. Factors associated with being underweight were male sex, mother being unemployed, and households not having enough food to eat for at least 2 days in the previous month. Factors associated with obesity were older age and time spent watching television. When overweight and obesity were combined in the analysis, they were inversely associated with increasing number of days spent playing sports. Our results show that the important nutritional risks for school-age children in the West Bank would seem to be the simultaneous occurrence of undernutrition and obesity. The study highlights the need to balance obesity management and prevention with interventions to tackle undernutrition.

Dental Caries Status, Socio-Economic, Behavioral and Biological Variables among 12-Year-Old Palestinian School Children.

There are currently inadequate data regarding the prevalence of dental caries and its associated variables, among Palestinian children. To determine the current prevalence of dental caries and related variables, among Palestinian children in East Jerusalem. A stratified sample of 286 East Jerusalem Palestinian children was selected, employing randomly chosen sixth grade clusters from three pre-selected socio-economic school groups. Dental caries was recorded according to WHO recommendations. Salivary flow, pH, buffer capacity and microbial parameters, were recorded according to previously employed methodologies. The mean level of caries experience, by DMFT, was 1.98 ± 2.05. This level was higher than those found among Israeli children, but lower than several other Middle Eastern countries. In uni-variate analysis, significant associations were revealed between caries and school categories, which indicated lower, middle and higher socio-economic position(SEP), mothers' employment, home densities, dental visits, tooth brushing, Streptococci mutans (SM), Lactobacilli (LB), and saliva pH. According to a linear logistic regression model, children learning in lower SEP schools, with higher SM levels and more acidic saliva, had a higher chance of experiencing dental caries. These findings should be considered in the planning of services and dental health care programs for Palestinian children.

Labor and Related Injuries among Schoolchildren in Palestine: Findings from the National Study of Palestinian Schoolchildren (HBSC-WBG2006).

Background. Labor related injuries among Palestinian schoolchildren are a significant undocumented public health concern. This study aimed at documenting the prevalence and nature of work related injuries among schoolchildren as well as identifying sociodemographic factors that predict these injuries. Methods. A cross-sectional survey included 15,963 children of whom 6458 (40.8%) completed an optional package related to labor. Students aged 12–18 years self-completed the international WHO collaborative HBSC valid questionnaires between April and May of 2006. Results. Approximately 73.8% of the students who filled the optional package reported working during the last 12 months, of whom 79.1% sustained a work related injury. Work injuries were significantly higher among boys, younger children, and children enrolled in UNRWA schools and living in Gaza Strip (P < 0.05). Children working ≥3 hours/day were more likely to experience injuries, 1.73 (95% CI, 1.53–1.95), than those working ≤3/day. About half of the children worked in retail trade (51.5%), agriculture (20.0%), and cleaning (11.4%). Injury type was related to the type of work performed. Conclusions. The high prevalence of injuries among working Palestinian schoolchildren confirms its severity as a public health problem. To reduce occupational injuries, policymakers and professionals should develop intervention programs that target the public and health providers.

Salivary levels of mutans streptococci and Lactobacilli among Palestinian school children in East Jerusalem

The aim of the present study was to investigate the distribution of oral cariogenic bacteria among 12-year-old Palestinian children attending schools in East Jerusalem. Salivary levels of mutans streptococci (MS) and Lactobacilli (LB) were examined by semi-quantitative commercial kits and then correlated to social-demographic parameters. Overall, 52.1 % of the examined children presented the highest possible ranking score categories for MS bacteria, with only 5.4 % in the lowest category. Only 12.6 % of the school children presented the highest LB score, while 25 % had the lowest ranking score. Salivary MS levels in children attending private schools were lower than those of children in government schools and United Nations Relief and Works Agency (UNRWA) schools. Conversely, levels of LB were lowest in children attending UNRWA schools compared to government and private schools. Girls had significantly higher amounts of MS and LB than boys (p = 0.001). Lower MS levels were significantly related to the following socioeconomic variables: higher father's education level (p = 0.037), higher mother's education level (p = 0.063), mother's employment status (p = 0.012), and lower home density (p = 0.001). For LB, the only significant socioeconomic variable was higher father's employment level, which was related to lower LB level (p = 0.025). Levels of MS and LB were found to be strongly related with socioeconomic status among Palestinian children in East Jerusalem. The relatively high prevalence of cariogenic bacteria suggests that oral care prevention and treatment demands special attention from the health care institutions and authorities.

Symptoms of PTSD among Children Living in War Zones in Same Cultural Context and Different Situations

Situations of war and military conflict have been linked to the development of PostTraumatic Stress Disorder (PTSD). To our knowledge, there are no studies that have examined, within the same conflict and the same culture, exposure to different traumatic events or traumatic events of different intensity. The aim of this study was to evaluate the symptoms of PTSD among Palestinian schoolchildren in two different areas of Hebron. A total of 381 schoolchildren from different parts of Hebron participated in the study. To evaluate the symptoms of PTSD, the children were asked to complete the Child Post Traumatic Stress Reaction Index. To evaluate the traumatic events experienced, they completed the Gaza Traumatic Event Checklist. Results indicate that 77.4% of the children living in Hebron show symptoms of moderatetosevere PTSD, and 20.5% of them meet the DSMIV diagnostic criteria for chronic PTSD. There were no significant differences in total symptoms between the two areas of Hebron, but there were differences within the specific types of symptoms. It is clear that the traumatic events of the war lead to the development of posttraumatic stress in children and that psychological intervention

Blood lead level among Palestinian schoolchildren: a pilot study

In Palestine, chronic exposure to lead has not been adequately addressed as a problem for children. To assess the exposure of Palestinian schoolchildren, we surveyed blood lead levels in 3 schools in Nablus city and collected demographic and clinical data. Blood samples were collected from 178 children (140 boys, 38 girls), age range 6-8 years. The overall mean blood lead level was 3.2 (SD 2.4) microg/dL, and 4.5% of children had levels above 10 microg/dL. Blood lead levels were significantly higher among children living in refugee camps near industrial/high traffic regions than among children living in residential areas of the city. Blood lead levels were positively correlated with family size (r = 0.15) and negatively correlated with household area (r = -0.18). Blood lead levels among these Palestinian schoolchildren were higher than those of other countries where leaded gasoline has been banned and seemed to be higher in more economically deprived children.

Double burden of undernutrition and obesity in Palestinian schoolchildren: a cross-sectional study

Background Previous studies of nutrition were undertaken in adolescent schoolchildren in the West Bank or Gaza Strip, occupied Palestinian territory; most of the children were selected from only a few geographical areas. We assessed factors associated with stunting (height-for-age standardised scores Methods We surveyed a sample of 22 schools run by the UN Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) and Palestinian Government. Using UNRWA's and the government's lists, we selected 1500 students from those attending school at the time the study was undertaken. We selected a set number of students per class from the first (mean age 6·71 years [SD 0·45]), sixth (11·82 years [0·57]), and ninth grades (14·83 years [0·61]), with a 1:1 ratio of boys to girls. The number of classes in each grade was between one and five. Siblings were excluded; we selected one student per household. We stratified the lists of students attending the UNRWA and government schools by location and sex. Within each school, 42 students per grade were selected using random sampling and recruited to the study—eg, if there were two classes A and B, we randomly selected 21 students from the alphabetical list for each class. BMI was defined according to age-specific and sex-specific cutoff values reported as per the 2000 growth charts of the Centers for Disease Control and Prevention, Atlanta, GA, USA, and height and weight measures as per WHO standards. Columbia University's Institutional Review Board, New York, NY, USA, approved the study protocol in December, 2008. Written informed consent and assent were obtained from sixth and ninth grade students and their parents. Findings Data were obtained from 1484 (99%) of 1500 students. Prevalence of stunting was 97 (7%) of 1446 and underweight 94 (7%) of 1444 students. 180 (12%) of 1444 students were overweight and 86 (6%) obese. There were non-significant differences in stunting (52 [7%] of 772 vs 45 [7%] of 674; difference 0·98, 95% CI 0·67–1·44; p=0·96), underweight (25 [3%] of 771 vs 24 [4%] of 673; 0·92, 0·52–1·58; p=0·73), and overweight (99 [13%] vs 81 [12%]; 1·07, 0·81–1·40; p=0·64) between the children in government and UNRWA schools. Obesity was more prevalent in UNRWA schools than in government schools (56 [7%] vs 30 [4%]; 1·63, 1·06–2·51; p=0·0246). The hunger index, which is a composite score from the eight questions on the food insecurity questionnaire, was negatively associated with height for age (p=0·018). Factors associated with underweight were male sex (odds ratio 2·8, 1·5–5·3; p=0·002), mother being unemployed (3·0, 1·0–8·4; p=0·04), and households not having enough food to eat for at least 2 days in the past month (1·8, 1·0–3·3; p=0·05). Factors associated with obesity were age, with children in the ninth grade more likely to be obese (1·1, 1·02–1·2; p=0·01) than were younger children, and time spent watching television (1·1, 1·0–1·3; p=0·014). When overweight and obesity were combined in the analysis, they were significantly and inversely associated with increasing number of days spent playing sports (0·87, 0·77–0·98; p=0·02). Interpretation By contrast with the results of previous studies, our data do not suggest an association between birth order, birthweight, size of the household, maternal education, and the child's nutritional status. Our results show the need to target food insecurity and improve child health in the occupied Palestinian territory, partly through increased awareness and promotion of sustainable healthy lifestyle changes for the prevention and management of undernutrition and obesity. The dissemination of information about the social, emotional, and cognitive effects of regular physical activity should be integral to health and nutrition programmes. We need to focus simultaneously on food insecurity and the establishment of a simple and reliable system for the detection of malnutrition; and we need to implement programmes related to the negative effects of adverse lifestyles. Funding UNRWA, UNICEF, Juzoor for Health and Social Development, Institute of Human Nutrition, Columbia University, and Flagship Project.

Living in the shadow of occupation: Life satisfaction and positive emotion as protective factors in a group of Palestinian school children

Abstract Starting from perspectives on functioning and wellbeing, the aim of the present study was to investigate positive and negative affect, self-perceived life satisfaction and happiness in a group of 74 Palestinian children exposed to political violence. We hypothesized that the children in our sample would display generally satisfactory wellbeing and good functioning in terms of positive affect, life satisfaction and happiness, despite their negative life conditions. Both quantitative and qualitative analysis of the dimensions of participants' wellbeing was carried out. In particular, we explored the ecological dimensions affecting the wellbeing of Palestinian children through content analysis of narratives produced by the group of participants. Positive emotions were found to contribute to wellbeing and life satisfaction in children, acting as protective factors in dealing with daily violence. The children displayed a range of personal resources facilitated above all by the functioning community structure supporting them. Implications for clinical intervention are discussed.

Attention deficit-hyperactivity symptoms among Palestinian children

We aimed to establish the prevalence and distribution of attention deficit-hyperactivity disorder (ADHD) symptoms and other associated comorbid mental health problems in Palestinian schoolchildren. Thus 349 children aged 6-15 years were randomly selected from 23 schools in Gaza and the West Bank and were rated by their parents and teachers using both the ADHD DSM-IV Checklist and the Strengths and the Difficulties Questionnaire, which also measures conduct and emotional problems. There was a significant agreement between parents and teachers, with 4.3% of the children rated above the established cut-off scores on both the parent and teacher DSM-IV Checklist. Male gender, family size and living in an area of socioeconomic deprivation were independently associated with ADHD symptoms.

Psychological reactions to Israeli occupation: Findings from the national study of school-based screening in Palestine

Children exposed to violent war-like and repeated political violence often experience a continued threat to life and their sense of safety, as well as a disruption of daily functioning. The purpose of the study was to examine the psychological impact of exposure to Israeli occupation on Palestinian school children in the West Bank and Gaza, Palestine. We assessed the association between exposure to occupation and the severity of posttraumatic symptoms and the inter-relationship between posttraumatic symptoms, functional impairment, somatic complaints, and coping strategies in school children. Palestinian students (n = 2100) from grades 9—11 were screened from both the West Bank (n = 1235) and Gaza (n = 724) and responded to self-report questionnaires. Results showed that extensive exposure to violence was associated with higher levels of posttraumatic distress and more somatic complaints in both the West Bank and Gaza regions. More Gaza than West bank students reported symptoms meeting the criteria for PTSD, and more girls than boys in both groups reported somatic complaints. Thus, school-based screening can be an effective method for case identification of students showing PTSD symptoms as a result of exposure to political violence.