ultra-Orthodox Jewish Community Research Articles

Unorthodox Information Sources of Coping With the COVID-19 Crisis in the Ultra-Orthodox Society

This study examines the role of information sources in the ultra-Orthodox (Haredi) Jewish community’s coping with the coronavirus (COVID-19) pandemic in Israel by comparing their use of digital versus traditional information platforms. The study examined coping with COVID-19, considering explanatory variables such as Community Sense of Coherence (C-SOC), Internet usage, and other demographic variables. Using an online survey, 212 participants responded who identified as ultra-Orthodox and had access to the Internet, of which 47.2% were women and 52.8% were men, with a mean age of 37.66 ( SD = 12.60). Findings showed that the emotional and cognitive coping levels of members of ultra-Orthodox society with COVID-19 utilizing digital information sources were significantly better than those among community members using traditional information sources. Furthermore, the more the Internet was used for information or social needs, the more digital information sources helped community members cope with the crisis from an emotional and cognitive viewpoint. Conversely, the more participants felt that ultra-Orthodox society is a significant factor that helps them face life’s challenges (C-SOC), the better they coped with the pandemic utilizing traditional information sources. This study presents a novel, previously unstudied approach to ultra-Orthodox society’s coping methods with a worldwide crisis, whether through digital or traditional information sources. The study’s findings emphasize the need to make reliable and timely digital information accessible to this community, especially during a crisis, while respecting the culture and values of ultra-Orthodox society.

Using societal conditional regard to cope with drug use in the ultraorthodox community and the unintended consequences.

A developing theoretical framework for the investigation of tight cultures' reaction toward members who violate communal norms is societal conditional regard (SCR). Using a qualitative interpretive approach, in the current study we investigated the way the Ultraorthodox Jewish community uses SCR to cope with substance use disorders (SUDs), which considered to be a norms violation in closed religious communities. We did so by drawing on in-depth interviews with 14 young men from the Ultraorthodox community in Israel who were diagnosed as having an SUD and were in recovery. (a) The community's socialization process, educating its members to lead a life that is the only right one; (b) The community's use of God as the one whose love and regard are conditional; (c) The SCR emotional and behavioral practices used by the community toward individuals who violate norms, and (d) How, paradoxically, the use of SCR may eventuate in the initiation of drug use, and within the community itself. Findings are discussed in the context of self-determination theory and SCR, and shed light on how tight cultures cope with the threat of deviation of communal norms. Implications for intervention and policy are outlined.

Motives for Vaccination Against COVID-19 Among the Ultra-orthodox Jewish Community in Israel.

According to official data, the ultra-Orthodox group in Israel had the highest COVID-19 infection rate yet the lowest vaccination rate compared to the general population. The present study aimed to explore the rate of vaccine uptake as well as reported reasons for vaccine avoidance. In addition, we examined whether several protection motivation theory (PMT) components are good predictors of vaccine uptake. The components we addressed were: perceived susceptibility to the threat of COVID-19, perceived severity of the virus, and perceived efficiency and safety of the vaccine (i.e., response efficacy). The sample included 623 individuals (337 men) aged 18 + who were drawn from a database of a survey company specializing in the ultra-Orthodox community. We conducted a cross-sectional online survey between June 22, 2021, and July 7, 2021, approximately six months after the beginning of vaccination distribution.Results revealed that 65.8% of the participants (versus 89% of the general population) were vaccinated. Women were vaccinated at lower rates than men, whereas those in the Misnagdim ultra-Orthodox subgroup were vaccinated at higher rates than other subgroups in that community. The most prominent reasons for vaccine avoidance were perceived immunity based on prior infection by the virus and lack of trust in the vaccine's safety. In support of the PMT model, the perceived severity of the virus and the vaccine high efficacy were significant predictors of vaccine uptake. The study results call for better outreach to this community and specific psycho-education interventions tailored for its women.

Development of a psychological health promotion intervention for ultra-orthodox Jewish mothers of children with ADHD using the intervention mapping protocol

BackgroundAttention Deficit Hyperactivity Disorder (ADHD) is a common neuro-developmental health condition in children and adolescents, in which its associated behavior manifestations are known to negatively affect members of the family unit, especially mothers. Ultra-orthodox Jewish (UOJ) community is growing globally and mothers of children with ADHD in this community are potentially at risk for negative health outcomes. As the UOJ community is culturally conservative, maintaining a distinct separation from outside influences, they often avoid utilizing public mental health services due to stigma and a lack of culturally sensitive treatments. Thus, this study aimed to develop a theory-driven and culturally appropriate psychological health promotion intervention for these mothers using the Intervention Mapping protocol.MethodsA mixed-method design was used. Qualitative content analysis was performed on four focus groups (n=25). Additionally, descriptive statistics including the content validity index was used to measure feedback regarding the developed intervention protocol’s relevance, effectiveness, and appropriateness Theoretical models for behavior change, including the Behavior Change Wheel’s COM-B system and the Theoretical Domains Framework, and literature on ADHD in the general population and the ultra-orthodox community were integrated in the process. Intervention components were systematically derived from findings.ResultsKey determinants of health behavior change were identified, resulting in formulating intervention objectives addressing stigma reduction surrounding ADHD, increasing knowledge about the ADHD condition and treatment, awareness of the school systems’ capabilities in meeting the ADHD child’s needs, enhancing mothers’ advocacy skills, and maternal self-care. Intervention? strategies included a group setting, providing information on health consequences, social support, re-attribution, active learning, goal setting, and promoting an identity associated with the desired behavior change. Mothers’ quantitative feedback confirmed the overall relevance, effectiveness, and appropriateness of the interventions’ content (CVIavg= .86, .85, .87).ConclusionsIntervention Mapping facilitated the development of a culturally sensitive psychological health promotion intervention for ultra-orthodox Jewish mothers of children with ADHD. Further research is warranted to assess intervention feasibility and effectiveness.

Social Work Programs for the Ultra-Orthodox Jewish Community: Shaping a Professional Identity and Meeting the Needs of the Community

ABSTRACT The ultra-Orthodox Jewish community is characterized by its strict religious observance and is a relatively self-secluding group existing as an enclave system. In the last few decades, a growing number of ultra-Orthodox Jews have pursued social work degrees. Social work is a profession that shares many of the ultra-Orthodox Jewish community’s values, such as helping those who are in need. However, social work education and practice are also based on liberal-humanist approaches which may conflict with the community’s adherence to the Jewish law (halacha). To overcome some of these obstacles, and in order to meet their unique needs, there are a few programs accredited by the Council on Social Work Education which are designed to teach social work to ultra-Orthodox Jews. We interviewed 21 graduates of such programs to learn about their experiences pursuing a master’s in social work. The results of this study indicate that these programs are culturally sensitive to the ultra-Orthodox community due to their gender-segregated classes, in-house rabbi, respecting the Jewish calendar, and employing instructors who understand the needs of the community. We conclude with implications for future research and policy recommendations to assess the fidelity of these programs and whether they sacrifice essential values of social work.

Public stigma toward women, mothers and non-mothers, with serious mental illness in Jewish Ultraorthodox society

ABSTRACT The study aimed to investigate stigma toward women with serious mental illness (SMI) within the Jewish Ultraorthodox community. It explored the impact of target motherhood, observers’ parenthood, and psychological-flexibility on stigma. 150 participants were presented with a vignette depicting a woman with\\without SMI and as mothers\ on-mothers, then surveyed for their attitudes and social distance. High levels of stigma were found toward women with SMI regardless of their motherhood status. Interestingly, observers’ parenthood correlated with increased social distance, and high psychological flexibility was linked to lower stigma. A third-level interaction was found in which there was a moderating effect of psychological flexibility on the interaction between target person’s motherhood, target person’s SMI, and stigma. The study highlights the need for culturally sensitive approaches and emphasises the significance of considering parenthood and psychological flexibility in combating stigma toward individuals with SMI in collectivistic religious societies like the Jewish Ultraorthodox community.

"Sense for Gambling" Among Jewish Ultra-Orthodox Men With Gambling Disorder.

Making sense of the social world is an intricate process heavily influenced by cultural elements. Gambling is a prevalent leisure-time activity characterized by risk-taking conduct. While some individuals who engage in it do so without experiencing any harm, others will develop gambling problems. Judaism tends to perceive gambling negatively since it contradicts fundamental Jewish principles. The current study focuses on the Jewish Ultra-Orthodox community in Israel which is characterized as a cultural enclave with minimal interaction with the secular world. Hence, it provides a unique and novel socio-cultural context to inquire how individuals with gambling disorder (GD) from this community make sense of gambling. Following constructivist grounded theory guidelines, 22 Ultra-Orthodox men with GD were interviewed using a purposeful sampling design. Sixteen Rabbis were also interviewed, illuminating the socio-cultural context of Halachic regulations and norms regarding gambling in this community. An abductive analysis of the data, interwoven with Bourdieu's concept of habitus, yielded an overarching theme that we dub as "sense for gambling," encompassing matrices of Ultra-Orthodox external (e.g., a conservative cultural structure with numerous prohibitions and life marked by poverty) and internal (e.g., feelings of loneliness, dissatisfaction, and deviance) dispositions imprinted onto the body, creating diverse embodied reactions (emotional and sensory) to gambling, and leading to developing GD. We recommend placing the body, as the locus of internalized dispositions, at the core of examination when researching pathways to GD. We propose that this intricate interplay between external and internal dispositions shapes the decision-making regarding gambling, thus mitigating individual responsibility for GD.

Predicting Psychopathology in Jewish Ultra-Orthodox IPV Survivors: A Machine Learning Approach

The nature of the abuse, cultural and religious values, trauma-related cognitions, and recovery actions are considered factors that shape intimate partner violence (IPV) survivors’ recovery and pathology. However, less is known about their specific impact on women’s psychopathology and wellbeing. Concomitantly, there is scant information about IPV survivors from collectivistic societies such as the Israeli Jewish Ultra-orthodox (JUO) community. The present study was designed to identify predictors of post-traumatic stress (PTSD) symptoms and wellbeing in women from the JUO community who have experienced IPV. Women (N = 261) provided information about their demographics, the nature of the violence, attitudes with respect to cultural and religious norms that normalize violence, trauma-related cognitions, the coping constructs of disengagement, faith, and engaging in help-seeking and recovery actions, and the PTSD symptoms that affect their wellbeing. A Random Forest machine learning (ML) algorithm was used to identify the strongest predictors of psychopathology and wellbeing. Regression trees were developed to identify individuals at greater risk of PTSD symptoms but also of greater wellbeing. Higher self-stigma and the perception of an unsafe world were associated with PTSD symptoms, whereas lower self-stigma, greater faith, and engagement in steps toward recovery were associated with greater wellbeing. These findings highlight the importance of treating women’s self-stigma and perceptions of an unsafe world while also encouraging faith and active engagement in recovery to promote survivors’ wellbeing and lessen their PTSD symptoms.

Modesty, religion, and community: Therapists' perspectives regarding the treatment of child sexual abuse in the ultra-orthodox community

BackgroundReligion is a significant cultural component that impacts child sexual abuse (CSA) in various ways, including its definition, perception, and treatment. This study focuses on the Jewish ultra-Orthodox community in Israel, a strictly religious, segregated, and close-knit community with unique cultural practices and beliefs that impact children's safety and vulnerability to CSA. ObjectiveThis qualitative study aimed to explore therapists' perceptions and ascribed meanings of CSA treatment within the ultra-Orthodox community. Participants and settingThirty in-depth interviews were conducted with therapists working with the ultra-Orthodox community in Israel. MethodsThe interviews were analyzed using thematic qualitative analysis. ResultsThree central axes pertinent to the treatment of CSA in the ultra-Orthodox community were discovered: 1) religious interventions, 2) modest approach, relating to the community's taboo attitude towards sexuality; and 3) the collectivistic nature of the community. The results include specific effect sizes and their statistical significance. ConclusionsThe discussion explores the findings in light of the literature on CSA among religious minority communities and connects them to the unique underlying perception of sexuality in the ultra-Orthodox community. Specific ramifications and recommendations for practice are then considered, alongside the limitations and directions for future study.

Covid-19, identity, and piety online: ultra-Orthodox discussions in WhatsApp and Telegram groups under social distancing regulations

ABSTRACT The Covid-19 pandemic has disrupted relationships between religious communities and the state. Churches, religious authorities, and believers have been obligated to modify key activities (prayer, ceremonies) and weigh their religious identity against state prohibitions. Accordingly, we ask how members of a reclusive religious community negotiated and performed their identity under a prolonged emergency. We analyse intra-communal discourse concerning the state’s social distancing regulations during Covid-19 outbreaks and lockdowns that occurred in closed groups in messaging apps. Specifically, this research case-studies Jewish ultra-Orthodox communities in Israel (Haredim). Extensive analysis of over 2,000 WhatsApp and Telegram posts in 35 ultra-Orthodox groups over a two-year period indicates that participants constantly sought to affirm their primary, dominant, communal identity. While efforts to integrate adherence to state prohibitions into this primary identity were evident, these efforts were well accepted only when justifying them via affirmation of the communal identity – superseding medical, political, and practical concerns. The findings advance understanding of minority groups’ attitudes towards state directives and illuminate contemporary pathways of identity dynamics in online social networks. The findings may also be applicable in a broader sense to the study of discourse dynamics in echo chambers and filter bubbles.

Fostering childbirth education on upright positions and mobility during labor in nulliparous women

BackgroundUpright labor positions and movement during labor have a positive effect on childbirth, yet the predominant labor positions are still horizontal. Therefore, it is important to explore how it is possible to improve childbirth education, particularly its instructional design, to strengthen women’s self-efficacy toward the use of upright positions and mobility during labor. The aim of the study was to evaluate the impact of an instructional approach based on a cognitive engagement ICAP (Interactive, Constructive, Active, Passive) framework on the development of knowledge, attitudes, and self-efficacy expectations toward upright positions and mobility during labor.MethodsA prospective quasi-experimental study was conducted among nulliparous women from the ultra-orthodox Jewish community (n = 74). While the control group (n = 34) participated in routine childbirth education, the intervention group (n = 36) learned with childbirth education that included interactive and constructive cognitive engagement activities. Participants in both groups completed a set of questionnaires regarding knowledge, attitudes, and self-efficacy.ResultsThe post-test analysis revealed that women in the intervention group compared to the control group gained significantly higher knowledge scores (p < 0.05), more positive attitudes (p < 0.001), and stronger self-efficacy expectations toward upright positions and mobility during labor (p < 0.01).ConclusionsThe findings suggest that by fostering women’s cognitive engagement levels during childbirth education toward the interactive and constructive modes of the ICAP framework, women’s self-efficacy to move during labor and to use upright positions can be induced. These results can serve as a foundation to improve the overall effectiveness of childbirth instruction.Trial registrationThe study was registered retrospectively.

Barriers and enablers to vaccine uptake in the Ultra-Orthodox Jewish population: a systematic review

Abstract Background The Jewish Ultra-Orthodox (UO) population is an undervaccinated minority group that has been disproportionally affected by outbreaks of vaccine-preventable diseases (VPD) such as measles and polio. Underlying reasons remain poorly characterized. We aimed to identify vaccination barriers and enablers in this population. Methods We systematically reviewed the literature, searching Pub-med, Web of science, Medline, PsychNet and Scopus from 1995 to 2021 for quantitative and qualitative primary research in English. We assessed included publications for quality and extracted relevant data based on the 5As taxonomy: access, awareness, affordability, acceptance and activation. Results We included 9 qualitative and 7 quantitative studies from the 125 studies identified. Access barriers included scheduling difficulties, inconvenient opening hours, and logistical difficulties related to having multiple young children. Acceptance barriers included safety concerns. Insufficient knowledge about the importance of vaccines and timely vaccination and the perception of being shielded from infections because of seclusion from wider society were key awareness barriers. Competing priorities, such as work and housework, were the main affordability barriers. Mainstream religious leadership's support for vaccination was an enabler, although recent studies suggest their influence on vaccination behavior is decreasing and the influence of anti-vaccination messages is growing. Conclusions Barriers to vaccination among the UO were mainly logistical, with little religious framing. Safety and efficacy concerns were similar to those reported in the wider community. Decreasing influence of the traditionally pro-vaccine mainstream religious leadership and growing influence of anti-vaccination movements targeting the UO community are new phenomena that require close monitoring. Tailored interventions are required to protect the community and wider society against future VPD outbreaks. Key messages • Vaccination barriers in Ultra-Orthodox Jewish communities are due mainly to logistical challenges, such as competing priorities in large families with young children. • Religious leadership is the main enabler of vaccination in Ultra-Orthodox Jewish communities, but their declining authority and exposure to antivaxx materials is causing a shift in attitudes.

Queering Eve: Imagining Transgender Acceptance in Orthodox Judaism

While the Reform and Conservative Jewish movements have made a concerted effort to welcome transgender Jews in the last twenty years, transgender congregants are often shunned by Orthodox rabbis and synagogues in the United States. Studies about Orthodox Judaism’s relationship with transgender identity often focus exclusively on Talmudic justifications for the acceptance or rejection of transgender Jews, ignoring the increasingly sizeable effect that secular politics has on the American Orthodox community. To address this gap in the academic understanding of transgender Jewish issues, this analysis takes a more holistic approach to the issue of transgender acceptance in Orthodox Judaism by (1) assessing the potential for the acceptance of transgender Jews in ultra-Orthodox and Modern Orthodox Jewish communities in the United States using halakhic rulings on intersex and transgender issues and (2) tracing the potential effects of the American political landscape on the Orthodox community’s acceptance of transgender identity.

Awareness, Incidence and Psychological Wellbeing of Childhood Sexual Abuse as Reported by Ultra-Orthodox Mothers

ABSTRACT The harm caused by child sexual abuse (CSA) is well-documented, calling for more awareness and efforts at prevention. However, CSA in closed religious societies is still tightly under wraps, and therefore underreported and understudied. We chose to use the mother’s point of view, in order get an estimate of the prevalence, the reporting rates and their psychological wellbeing. The current study aims at addressing this in the Jewish ultra-Orthodox community, an insular religious one, which may thus serve as a test case for understanding other closed, religious communities. Three hundred forty-seven ultra-Orthodox Israeli women completed self-report questionnaires and reported on their, or their children’s exposure to CSA sexual abuse, about their emotional coping, and about considerations regarding disclosing the abuse. About 24% the participants reported that they were victims of sexual abuse. Only 24.3% of cases were reported to the police or official welfare services, with cultural reasons offered by the women to explain it. Lower psychological wellbeing was found among mothers who themselves or their children were victims of child sexual abuse, compared to controls. Interestingly, mothers who reported having undergone psychological treatment suffered a higher degree of distress than those who had not. These findings contribute to the understanding of the dynamics of sexual abuse exposure and disclosure in the ultraorthodox community, and in close societies and highlight the changes required to improve safeguarding of children.

Enlisting in the army in the Jewish Ultraorthodox community and the consequences for wellbeing.

Israeli law requires citizens to enlist in the army at 18 years old. However, the Jewish Ultraorthodox community has a longstanding agreement with the state that members of this community will not have to enlist in the army, given its spiritual leaders' strong opposition. Still, there are young men who go against the communal norms and enlist. In the current study we investigated these young men and the contribution of their self-esteem (a personal resource), their sense of community (a communal resource), and the community members' attitudes toward them (societal conditional regard, both positive and negative, and stigma) to their wellbeing. The current study consisted of 153 participants between the ages of 20 and 55 (M = 29.64, SD = 6.89). A path analysis model indicated the protective role played by self-esteem and sense of community in participants' wellbeing, and the risk factor posed by societal conditional negative regard and stigma. Moreover, self-esteem was found to mediate between income and wellbeing, whereas sense of community was found to mediate between societal conditional negative regard and wellbeing, and between stigma and wellbeing. The discussion highlights the complexity of the protective role played by sense of community against the risk of experiencing societal conditional negative regard and stigma. It also addresses the importance of promoting intervention programs during the army service of these young men, with a focus on promoting their self-esteem and on the presence of a spiritual leadership that legitimizes working, serving in the army, and yet still being part of the community.

The COVID-19 Israeli tapestry: the intersectionality health equity challenge

BackgroundCOVID-19 is disproportionately affecting disadvantaged populations, with greater representation and worse outcomes in low socioeconomic and minority populations, and in persons from marginalized groups. General health care system approaches to inequity reduction (i.e., the minimization of differences in health and health care which are considered unfair or unjust), address the major social determinants of health, such as low income, ethnic affiliation or remote place of residents. Yet, to effectively reduce inequity there is a need for a multifactorial consideration of the aspects that intersect and generate significant barriers to effective care that can address the unique situations that people face due to their gender, ethnicity and socioeconomic situation.Main bodyTo address the health equity challenges of diverse population groups in Israel, we propose to adopt an intersectional approach, allowing to better identify the needs and then better tailor the infection prevention and control modalities to those who need them the most. We focus on the two main ethnic – cultural—religious minority groups, that of Arab Palestinian citizens of Israel and Jewish ultra-orthodox (Haredi) communities. Additionally, we address the unique needs of persons with severe mental illness who often experience an intersection of clinical and sociodemographic risks.ConclusionsThis perspective highlights the need for responses to COVID-19, and future pandemic or global disasters, that adopt the unique lens of intersectionality and equity. This requires that the government and health system create multiple messages, interventions and policies which ensure a person and community tailored approach to meet the needs of persons from diverse linguistic, ethnic, religious, socioeconomic and cultural backgrounds. Under-investment in intersectional responses will lead to widening of gaps and a disproportionate disease and mortality burden on societies’ most vulnerable groups.

Attributions of LGBTQ+ Identity and Religious Views on Homosexuality to Disaffiliation from Orthodox Judaism

Religious disaffiliation has been found to occur at higher rates in LGBTQ+ individuals than in heterosexual individuals and in the general population. In this brief report, we explore whether LGBTQ+ people who disaffiliated from Orthodox Judaism attributed sexual identity and/or Orthodox Judaism’s lack of acceptance of homosexuality to their disaffiliation. This analysis focuses on 117 individuals who identified as LGBTQ+ who were drawn from a larger study that included 387 participants across all sexual orientations who disaffiliated from Orthodox Judaism. Unexpectedly, only 18 of the respondents reported that their sexual identity and/or religious views on homosexuality were causes for their disaffiliation. A lack of education and language around LGBTQ+ concepts in ultra-Orthodox Jewish communities may have contributed to this finding. We suggest that additional research be conducted to explore the complex relationship between LGBTQ+ identity and disaffiliation from Orthodox Judaism.

Depression, PTSD, and suicidal ideation among ex-ultra-Orthodox individuals in Israel

ABSTRACT Introduction: Disaffiliating from an ultra-Orthodox society is complex and challenging. The process includes dealing with culture shock, traumatic experiences, education gaps, and disconnection from familiar surroundings. Thus, ex-ultra-Orthodox individuals (ex-ULTOIs) may face loneliness, lack of belongingness, and loss of meaning, which may relate to high psychological distress such as depression and suicide ideation. In the present study, we sought to shed light on the distress of ex-ULTOIs in Israel and to understand the disaffiliation-related characteristics that may relate to their distress levels. Method: The sample comprised 755 participants, aged 19–54, who left their ultra-Orthodox Jewish lifestyle and communities. Participants completed self-report questionnaires tapping depression, anxiety, posttraumatic stress disorder (PTSD) symptoms, suicide ideation and behaviour, as well as demographics and disaffiliation-related characteristics. Results: Nearly half of the sample (N = 332, 45.9%) reported symptom intensity meeting the current criteria for major depressive disorder. Moreover, 46.7% reported symptoms meeting PTSD criteria, and 34.5% reported having suicidal ideations in the past year. Hierarchical regression analyses revealed that the intensity of past negative life events, the nature of motives for disaffiliation, and the longer duration of the disaffiliation process contributed to the severity of distress. Conclusions: The study's findings reveal that ex-ULTOIs suffer from high mental pain levels, particularly depression, PTSD, and suicidal risk. Importantly, experiencing disaffiliation as traumatic and longer durations of the process may facilitate greater mental pain and distress symptoms. These findings emphasize that ex-ULTOIs must be continually assessed, especially when their disaffiliation processes are experienced as traumatic.

Mothering a Child with ADHD in the Ultra-Orthodox Community.

Mothers of children with ADHD are at risk for negative health outcomes. The socio-cultural environment and everyday experiences in life roles may influence psychological health and quality of life. The ultra-orthodox Jewish (UOJ) community is an insular community who is underrepresented in the research, and as such there are no studies exploring the experience of mothering a child in this community. Thus, this study aims to explore the lived experience of mothering a child with ADHD in the UOJ community. The study used a descriptive qualitative phenomenological approach. Ten UOJ mothers of children with ADHD underwent semi-structured in-depth interviews to explore their lived experiences of mothering a child with ADHD. Thematic analysis was carried out on the transcripts. Four main themes, along with several subthemes, emerged from the qualitative analysis: child ADHD manifestations, maternal role, social factors, and self-care. Unique characteristics of the UOJ culture were apparent throughout the themes. UOJ children with ADHD display similar manifestations of symptoms in daily life to those in the general population and maternal burden is similarly present. However, unique perceptions of their maternal role, social factors, and legitimacy for self-care shed light into the impact of this culture on their lived experience. Findings may help promote culturally sensitive health care and interventions for this understudied population.

"They didn't have any idea what drugs were": Pathways to substance use disorders among ultraorthodox Jewish males.

Substance use disorders (SUDs) are a worldwide phenomenon with very negative consequences, and belonging to a religious community is considered to be a protective factor against them. The pathways to SUDs have been investigated in many studies with the aim of helping us better understand this phenomenon and promoting effective intervention programs to prevent and manage it. However, there is a lack of knowledge regarding SUDs in closed religious communities such as the Ultraorthodox Jewish community. To fill this gap, in the current study we investigated the pathways to SUDs among 14 young men from the Ultraorthodox Jewish community in Israel who were diagnosed as having an SUD in the past and who had been in sustained remission for at least a year. Semi-structured, in-depth interviews consisting of open-ended questions were conducted. The findings highlighted two main themes: (a) A lack of support and attention from various systems, where participants reported sense of otherness or lack of belonging to family, educational institutions and community; a lack of responsiveness from those systems; a sense of rejection or exclusion; and a longing for belonging, and (b) A light in the darkness - someone who cares, in which the interviewees received some assistance, either in the period before or during drug use. Findings point to the unique experience of Ultraorthodox young men in their addiction process and shed light on the failure of the abovementioned systems to help these young men cope. Findings are discussed in the context of the theoretical perspectives of social capital theory and exclusion. Implications for intervention and policy are outlined.