ultra-Orthodox Jewish Research Articles

Rethinking economic socialization: the intersection of culture, gender and economic life in a religious enclave

Abstract This article explores how economic socialization serves as a bridge between individual economic behaviors and the broader social and cultural contexts that shape them. Drawing on a post-functionalist approach to socialization, the study examines the ultra-Orthodox Jewish (Haredi) community in Israel, where distinct gender roles, cultural norms and patterns of economic participation create a unique context for investigating divergent economic socialization pathways. Comparing four groups within the Haredi community—average/below-average and high-income women, men with work experience, and men who study at religious seminaries (Yeshiva/Kollel)—analysis of an original survey study reveals how differential exposure to economic life leads to significant variations in financial risk-taking, loss-aversion, financial literacy and competitiveness. The findings problematize explanations attributing economic gender gaps to innate differences, instead highlighting the profound impact of the cultural framing of gender roles vis-à-vis economic integration. By foregrounding economic socialization as a sociological phenomenon, the study contributes to discourses on culture’s role in economic behavior and opens new avenues for examining how individuals acquire economic dispositions through socialization pathways shaped by structural constraints and power relations.

Effects of adverse childhood experiences on observed parenting and children's behavior problems among Jewish and Arab Muslim families in Israel.

Research points to the substantial impact of parents' exposure to adverse childhood experiences (ACEs) on parents and their children. However, most studies have been conducted in North America, and research on ACEs effects on observed parenting or on intergenerational transmission of ACE effects is limited. We therefore studied families from diverse ethnocultural backgrounds in Israel and examined whether mothers' ACEs hampered maternal sensitivity and the quality of the home environment and whether mothers' psychological distress mediated these links. We also explored whether mothers' ACEs predicted children's behavior problems indirectly through maternal psychological distress and whether maternal sensitivity and the home environment attenuated this mediating path. Participants were 232 mothers (Mchild age = 18.40 months, SD = 1.76; 63.36% non-ultra-Orthodox Jewish, 17.24% ultra-Orthodox Jewish, 19.40% Arab Muslim). Results showed mothers' ACEs were directly associated with decreased maternal sensitivity. Mothers' ACEs were indirectly associated with more behavior problems in children through mothers' higher psychological distress, and maternal sensitivity moderated this indirect link; it was significant only for mothers who showed lower sensitivity. Findings emphasize the significant role ACEs play in early mother-child relationships. The importance of including ACE assessment in research and practice with families of infants and toddlers is discussed.

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.

Associations of the COVID-19 burden and various comorbidities of different ethnic groups in Israel: a cross-sectional study.

Coronavirus disease (COVID-19) is highly transmissible between human beings. We examined differences in the core families with COVID-19 severity and mortality and comorbidities between Arab and Jews and explored the factors associated with COVID-19 severity and mortality to find a genetic component. A cross-sectional study was conducted among 2240 COVID-19 patients (> 18 years of age) randomly selected by online panels and questionnaires in the native language (Hebrew or Arabic) during March 2021-June 2022. Multivariable linear regression models were used to assess correlations with COVID-19 disease severity and mortality. Overall, 1549 (69%) were Arabs and 691 (31%) were Jews. The proportion of participants who died from COVID-19 was higher among Arabs compared with Jews (66% vs. 59%), P < 0.001. The mean number of deaths from COVID-19 and patients with severe COVID-19 was higher in ultra-Orthodox Jewish, non-academic core families and those who lived in the city residence compared with secular, academic core families and who live in the village residence, P < 0.001. A multivariable linear regression model showed a significant association between metabolic, kidney, cardiovascular, and respiratory diseases with COVID-19 severity (B coefficient - 0.43, B coefficient - 0.53, B coefficient - 0.53, B coefficient - 0.42, respectively) and COVID-19 mortality (B coefficient - 0.51, B coefficient - 0.64, B coefficient - 0.67, B coefficient - 0.34, respectively), P < 0.001. COVID-19 severity and mortality were highly associated with comorbidities, ethnicity, social and environmental factors. Furthermore, we believe that genetic factors also contribute to the increase in COVID-19 severity and mortality and the differences rates of these between Arabs and Jews in Israel.

The Pictorial Interview of Children's Metacognition and Executive Functions (PIC-ME): Cultural Adaptation for Ultra-Orthodox Jewish Populations.

Executive functions (EFs) are strongly linked to attention deficit hyperactivity disorder (ADHD). The pictorial interview of children's metacognition and executive functions (PIC-ME) assesses children's self-perceptions regarding their EF. This study is aimed at describing the cultural adaptation of the PIC-ME to the ultra-Orthodox (UO) Jewish population in Israel. In the first of three stages, 30 occupational therapists, who were experienced in working with children with ADHD from the UO population, completed a questionnaire about the suitability of PIC-ME for the UO community. In the second stage, six therapists participated in a focus group to discuss the recommendations and the adaptations made following the first stage. In the third stage, 20 UO children aged 5-10 participated in the tool validation process. First stage: most of the items of the original tool were found to be appropriate in representing the EFs of UO children and did not need to be adapted. No significant differences were found between the boys' and girls' versions regarding the tool's adaptability. However, most of the therapists suggested that the pictures in both versions needed adaptations. Second stage: additional recommendations led to the development of a final adapted version. Third stage: over 70 percent agreement was found among UO children regarding the clarity of the adapted pictures. No significant differences were found between boys and girls or between age groups. This study presented wide agreement on the necessity for cultural adaptation of the PIC-ME to the UO population and described the adaptation process. Based on its face validity, the UO version may be a useful tool to assess the self-perception of EF among UO children. Further studies are needed to assess its psychometric properties and its usefulness as an outcome measure. The study findings may contribute to the cultural adaptation of other tools for culturally distinct populations.

"Our family sleeps deeply": The Presence of Others During Intrafamilial Child Sexual Abuse as Conveyed By Girls From Diverse Communities in Israel.

Child sexual abuse (CSA) is generally perceived as a crime perpetrated out of sight, without witnesses. Nevertheless, several researchers have explored the presence of others during incidents of abuse in regards to two main aspects: bystanders in extrafamilial CSA and bystanders' decisions whether or not to get involved. However, there is a dearth of knowledge regarding how children who experience abuse perceive and experience the presence of others during abusive incidents. The current study was designed to examine the experiences and perceptions of girls who experienced intrafamilial CSA (IFCSA) with respect to the presence of others, as conveyed during their forensic interviews. A thematic analysis of 24 forensic interviews was conducted with secular Jewish, ultra-Orthodox Jewish, and Muslim Arab girls, aged 4-14. The analysis identified four main themes: (a) the girls' perceptions of others' awareness of them being abused, (b) the girl's experiences of loneliness, (c) the girls' experiences of disclosing to the others present during the abuse, and (d) family dynamics. The discussion highlights the unique, multifaceted and elusive dynamics of IFCSA, calling into question the commonly held view that it happens only in secret. The girls' narratives highlighted their distress and pointed to the abusive and unbearable daily routine in which they live. In spotlighting their encounters with IFCSA, the girls focused on the feelings of guilt, shame, and isolation they experienced.

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.

COVID-19 vaccine compliance in adolescents with attention-deficit/hyperactivity disorder.

ObjectiveTo compare the rate of the administration of the Pfizer–BioNTech COVID-19 vaccinations between adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD) and non-ADHD subjects.MethodA retrospective chart review was performed on all adolescents aged 12–17 years registered at a central district in Israel from January 1st 2021 to October 31st 2021.ResultsOf the 46,544 subjects included in the study, 8241 (17.7%) were diagnosed with ADHD. Of them, 3% were PCR-COVID-19 positive. Among the patients with ADHD, the older adolescents were more likely to be vaccinated: 48.8% of those aged 12-15 years were vaccinated versus 59.6% of patients aged 16-17 years. The ultra-orthodox Jewish and Arab adolescents in the ADHD group were far less likely to be vaccinated (22.9% and 34.6%, respectively), compared to the adolescents with ADHD in the general population (60.5%). Girls were also somewhat more likely to be vaccinated.ConclusionsAdolescents diagnosed with ADHD had a higher COVID-19 vaccination rate compared to their non-ADHD counterparts. The vaccine uptake was lower amongst Arab and ultra-orthodox Jewish populations.

A test of faith? Attitudes of ultraorthodox Jewish parents of children with down syndrome toward prenatal testing

The Haredi (ultraorthodox Jewish) community in Israel presents distinct views on disability and prenatal testing compared to the pro-testing attitudes of the Israeli general public. Based on qualitative analysis of semi-structured interviews with Haredi parents of children with Down syndrome, this study explores the interplay between their personal experiences and community norms in the creation of views on disability and pregnancy management. The experiences of life with disability carry varied positive and negative aspects, for both secular and religious parents. However, while this variability sometimes led to re-consideration (for better or worse) of views on disability and prenatal testing among secular parents, we demonstrate that parenting a child with disability did not change the views of Haredi parents regarding the futility of prenatal testing and the value of disability. For them, the Haredi model of disability remained the dominant framework through which life is experienced.

Fighting a pandemic: sociodemographic disparities and coronavirus disease-2019 vaccination gaps-a population study.

BackgroundData suggest lower coronavirus disease-2019 (COVID-19) vaccination coverage among minority and disadvantaged groups. We aimed to identify interactions between sociodemographic factors associated with vaccination gaps.MethodsThis population study used Israeli National COVID-19 data (extracted: 10 May 2021). The analysis comprised 6 478 999 individuals age ≥15 years with aggregated area-level data on sex and age distribution and no COVID-19 history. We estimated vaccination hazard and cumulative incidence using the Fine and Gray competing risk model.ResultsOlder age and higher socioeconomic status (SES) were associated, with stepwise higher cumulative vaccination rates (age 20–24: 67%, age ≥ 75: 96%; SES 1–3: 61%, 4–5: 74.2%, 6–7: 82%, 8–10: 87%). We found the lowest vaccination rates in Arab (65%) and Ultra-Orthodox Jewish (54%) areas. SES modified the association in Arab neighbourhoods, with higher coverage than in the non-Orthodox Jewish reference group in SES 1–3 [adjusted hazard ratio (HR) = 1.06; 95% confidence interval (CI): 1.02–1.11], and gradually lower coverage in higher SES classes (SES 6–7: HR = 0.83; 95% CI: 0.79–0.87). Vaccination rates were also higher among younger Arabs (≤45 years) compared with age counterparts in the reference population group (age 25–34: HR = 1.18; 95% CI: 1.12–1.28) and lower than the reference group among Arabs age ≥45 years. Among Ultra-Orthodox Jews, vaccination HRs remained below one across age and SES classes.ConclusionsAge and SES modified the association between population group and vaccination coverage. Identifying the interplay between sociodemographic characteristics and the underlying explanations may improve targeted efforts, aimed at closing vaccination coverage gaps and mitigating COVID-19.

Inequalities in initiation of COVID19 vaccination by age and population group in Israel- December 2020-July 2021.

SummaryBackgroundCOVID19 vaccination coverage in Israel varies among population groups. Comparing crude coverage between groups is misleading because of different age structures and socio-economic differences. To describe inequalities in COVID19 vaccine initiation in Israel we analysed the interaction of age and population groups in terms of dose 1 vaccine coverageMethodsWe calculated cumulative age-specific first COVID19 vaccine coverage by population group (Ultra-Orthodox Jewish, Arab, General Jewish). We calculated the relative differences in vaccine coverage between population groups within each age group, and between age groups within each population, using ANOVA and binomial regression after adjusting for socio-economic statusFindings8,507,723 individuals in 268 cities were included. Compared with the general Jewish population, coverage was lowest in the Ultra-Orthodox population in all age groups (range -12% among 60+ to -52.8% among 10-19 years olds, p<0.001). In all groups, the proportion of vaccinated individuals in younger age groups relative to those aged 60+ decreased with decreasing age and were smallest in the Ultra-Orthodox groups. For example, within the general Jewish population, people aged 20-29 were 14% less likely to be vaccinated than those aged 60+ while within the Ultra-Orthodox population it was 34.5%InterpretationIn all age groups, the Ultra-Orthodox population had the lowest vaccine coverage. Differences persisted after adjusting for socio-economic status. The younger the age group, the more Ultra-Orthodox Jews were diverging from age peers in terms of initiating COVID19 vaccination, suggesting a generational effect. Tailored approaches are urgently required to encourage vaccination among under-immunized groups in IsraelFundingNo specific funding was received

Real-world safety data for the Pfizer BNT162b2 SARS-CoV-2 vaccine: historical cohort study

ObjectiveThe Pfizer BNT162b2 vaccine showed a reassuring safety profile in clinical trials, but real-world data are scarce. Bell's palsy, herpes zoster, Guillain–Barré syndrome (GBS) and other neurological complaints in proximity to vaccination have received special public attention. We compared their rates among vaccinated and unvaccinated individuals. MethodsIndividuals ≥16 years vaccinated with at least one dose of BNT162b2 were eligible for this historical cohort study in a health maintenance organization insuring 1.2 million citizens. Each vaccinee was matched to a non-vaccinated control by sex, age, population sector (general Jewish, Arab, ultra-orthodox Jewish) and comorbidities. Diagnosis of Covid-19 before or after vaccination was an exclusion criterion. The outcome was a diagnosis of Bell's palsy, GBS, herpes zoster or symptoms of numbness or tingling, coded in the visit diagnosis field using ICD-9 codes. Diagnoses of Bell's palsy and GBS were verified by individual file review. ResultsOf 406 148 individuals vaccinated during the study period, 394 609 (97.2%) were eligible (11 539 excluded). A total of 233 159 (59.1%) were matched with unvaccinated controls. Mean follow was 43 ± 15.14 days. In vaccinated and unvaccinated individuals there were 23 versus 24 cases of Bell's palsy (RR 0.96, CI 0.54–1.70), one versus zero cases of GBS, 151 versus 141 cases of herpes zoster (RR 1.07, CI 0.85–1.35) and 605 versus 497 cases of numbness or tingling (RR 1.22, CI 1.08–1.37), respectively. DiscussionNo association was found between vaccination, Bell's palsy, herpes zoster or GBS. Symptoms of numbness or tingling were more common among vaccinees. This study adds reassuring data regarding the safety of the BNT162b2 vaccine.

Assessment of Effectiveness of 1 Dose of BNT162b2 Vaccine for SARS-CoV-2 Infection 13 to 24 Days After Immunization

The BNT162b2 vaccine showed high efficacy against COVID-19 in a phase III randomized clinical trial. A vaccine effectiveness evaluation in a real-world setting is needed. To assess the short-term effectiveness of the first dose of the BNT162b2-vaccine against SARS-CoV-2 infection 13 to 24 days after immunization in a real-world setting. This comparative effectiveness study used data from a 2.6 million-member state-mandated health care system in Israel. Participants included all individuals aged 16 years and older who received 1 dose of the BNT162b2 vaccine between December 19, 2020, and January 15, 2021. Data were analyzed in March 2021. Receipt of 1 dose of the BNT162b2 vaccine. Information was collected regarding medical history and positive SARS-CoV-2 polymerase chain reaction test and COVID-19 symptoms from 1 day after first vaccine to January 17, 2021. Daily and cumulative infection rates in days 13 to 24 were compared with days 1 to 12 after the first dose using Kaplan-Meier survival analysis and generalized linear models. Data for 503 875 individuals (mean [SD] age, 59.7 [14.7] years; 263 228 [52.4%] women) were analyzed, of whom 351 897 had follow-up data for days 13 to 24. The cumulative incidence of SARS-CoV-2 infection was 2484 individuals (0.57%) during days 1 through 12 and 614 individuals (0.27%) in days 13 through 24. The weighted mean (SE) daily incidence of SARS-CoV-2 infection in days 1 through 12 was 43.41 (12.07) infections per 100 000 population and 21.08 (6.16) infections per 100 000 population in days 13 through 24, a relative risk reduction (RRR) of 51.4% (95% CI, 16.3%-71.8%). The decrease in incidence was evident from day 18 after the first dose. Similar RRRs were calculated in individuals aged 60 years or older (44.5%; 95% CI, 4.1%-67.9%), those younger than 60 years (50.2%; 95% CI, 14.1%-71.2%), women (50.0%; 95% CI, 13.5%-71.0%), and men (52.1%; 95% CI, 17.3%-72.2%). Findings were similar in subpopulations (eg, ultraorthodox Jewish: RRR, 53.5% [95% CI, 19.2%-73.2%]) and patients with various comorbidities (eg, cardiovascular diseases: RRR, 47.2% [95% CI, 7.8%-69.8%]). Vaccine effectiveness against symptomatic COVID-19 was 54.4% (95% CI, 21.4%-73.6%). In this comparative effectiveness study of a single dose of the BNT162b2 vaccine, results were comparable to that of the phase III randomized clinical trial.

A nationwide analysis of population group differences in the COVID-19 epidemic in Israel, February 2020-February 2021.

SummaryBackgroundSocial inequalities affect the COVID-19 burden and vaccine uptake. The aim of this study was to explore inequalities in the incidence and mortality rate of SARS-CoV-2 infection and vaccine uptake in various sociodemographic and population group strata in Israel.MethodsWe analysed nationwide publicly available, aggregated data on PCR-confirmed SARS-CoV-2 infections and COVID-19 deaths between March 2020 and February 2021, as well as the first three months of COVID-19 immunisation according to sociodemographics, including population group and residential socioeconomic status (SES). We computed incidence and mortality rates of COVID-19. Comparisons between towns with predominantly Arab, ultra-Orthodox Jewish (the minorities), general Jewish populations, and according to SES, were conducted using generalised linear models with negative binomial distribution.FindingsOverall, 774,030 individuals had SARS-CoV-2 infection (cumulative incidence 84•5 per 1,000 persons) and 5687 COVID-19 patients had died (mortality rate 62•8 per 100,000 persons). The highest mortality rate was found amongst the elderly. Most (>75%) individuals aged 60 years or above have been vaccinated with BNT162b2 vaccine. The risk of SARS-CoV-2 infection was higher in towns with predominantly Arab and ultra-Orthodox Jewish populations than in the general Jewish population, and in low SES communities. COVID-19 mortality rate was highest amongst Arabs. Conversely, vaccine uptake was lower amongst Arab and ultra-Orthodox Jewish populations and low SES communities.InterpretationEthnic and religious minorities and low SES communities experience substantial COVID-19 burden, and have lower vaccine uptake, even in a society with universal accessibility to healthcare. Quantifying these inequalities is fundamental towards reducing these gaps, which imposes a designated apportion of resources to adequately control the pandemic.FundingNo external funding was available for this study.

Placing the Blame: What If "They" REALLY Are Responsible?

The new coronavirus pandemic, COVID-19, has resurrected a number of historical and sociological problems associated with naming and blaming collectives for the origin or transmission of infectious disease. The default example of the false accusation in 2020 has been the case of the charge of well poisoning against the Jews of Western Europe causing the pandemic of the Black Death during the fourteenth century. Equally apparent is the wide-spread accusation that Asians are collectively responsible for the spread of the present pandemic. Yet querying group actions in times of pandemics is not solely one of rebutting false attributions. What happens when a collective is at fault, and how does the collective respond to the simultaneous burden of both false, stereotypical accusations and appropriate charges of culpability? The case studies here are of Ultra-Orthodox Jewish (Haredi) communities and the PRC during the 2020 outbreak of COVID-19.

Cardiovascular disease risk factors and health behaviors of ultra-Orthodox Jewish women in Israel: a comparison study

ABSTRACT Objectives: Women from low socio-economic, culturally insular populations are at increased risk for cardiovascular disease (CVD). The ultra-Orthodox Jewish (UOJ) community in Israel is a rapidly growing low socio-economic, insular, cultural-ethnic minority with numerous obstacles to health. The current cross-sectional study investigates CVD-related health behaviors and risk factors in a sample of UOJ females, comparing sample characteristics with the general population. Design: Self-administered questionnaires completed by a cluster randomized sample of 239 UOJ women included demographics, CVD-related health behaviors (consumption of fruit, vegetables, and sweetened beverages; hours of sleep; secondhand smoke exposure; and physical activity engagement) and risk factors (BMI, reported diagnoses of diabetes, high blood pressure, and heart disease). Results: Compared with the general population, UOJ women were less likely to consume 5 fruits and vegetables a day (12.7% vs. 24.3%, p < .001); more likely to consume ≥ 5 cups of sweetened beverages a week (18.6% vs. 12.6%, p = .019), and more likely to sleep <7 hours a night (62.0% vs. 50.6%, p = .002). UOJ women also reported less secondhand smoke exposure (7.2% vs. 51.4%, p < .001) and higher rates of physical activity recommendation adherence (60.1% vs. 25.6%, p < .0001) than the general population. Obesity was higher in UOJ women (24.3% vs. 16.1%, p < .0001). Increased parity and reduced moderate physical activity were associated with increased BMI. Increased parity was also associated with reduced sleep. Grand multiparous women (a 68% prevalence rate), in particular, were more likely to be overweight or obese than women with less than 5 children. Conclusions: This study suggests that health promotion interventions in this population target healthy weight maintenance, nutrition, and physical activity.

Cardiovascular disease risk factors of ultra-Orthodox Jewish women in Israel: a comparison study

Abstract Background Women from low socio-economic, culturally insular populations are at increased risk for cardiovascular disease (CVD). The ultra-Orthodox Jewish (UOJ) community in Israel is a difficult to access, rapidly growing low socio-economic, insular minority with numerous obstacles to health. The current study investigates CVD-related risk factors (RF) in a sample of OUJ women, comparing sample characteristics with the general population. Addressing the questions, 'Are UOJ women at increased risk for CVD?', 'Which RFs should be addressed beyond the general population's?', this study can inform public health initiatives (PHI) for this and similar populations. Methods Self-administered questionnaires completed by a cluster randomized sample of 239 women from a UOJ community included demographics, fruit, vegetables, and sweetened drink consumption, secondhand smoke exposure, physical activity (PA) engagement, and BMI. Population statistics utilized for comparison of demographic and cardiovascular risk factors were obtained from government-sponsored national surveys. Results Compared with the general population, UOJ women were less likely to consume 5 fruits and vegetables a day (12.7% vs. 24.3%, p&amp;lt;.001) and more likely to consume &amp;gt; 5 cups of sweetened beverages a day (18.6% vs. 12.6%, p=.019). UOJ women also reported less secondhand smoke exposure (7.2% vs. 51.4%, p&amp;lt;.001) and higher rates of PA recommendation adherence (60.1% vs. 25.6%, p&amp;lt;.0001) than the general population. Obesity was higher in UOJ women (24.3% vs. 16.1%, p&amp;lt;.0001). Conclusions This study suggests that PHIs in this population target healthy weight maintenance, nutrition, and PA. As a consequence of this study, the first CVD prevention intervention has been implemented in this population, targeting the identified RFs. Utilizing a mixed methods and community-based participatory approach, this innovative 3-year intervention reached over 2,000 individuals. Key messages This study identified nutrition risk behaviors and high levels of obesity in a difficult to access, minority population. This study informed the planning and implementation of a community-based PHI.

The “battle of sexes” construct among ultra-Orthodox Jews: what is the optimal number of children for a minimal BMI?

Obesity is a prominent risk factor for an extensive series of health problems as well as for higher mortality rates. This study demonstrates a conflict of interest (“battle of sexes” construct) between ultra-Orthodox Jewish (UO) females and males. The study is based on a panel dataset of up to four measured points in time (2012, 2013, 2014–2015, and 2016) generated by the Israeli Central Bureau of Statistics (ICBS). Based on this dataset, the methodology of the random-effect probit binary model is employed, where the dependent variable measures the projected probability of type I obesity. According to the outcomes obtained, this conflict of interest is unique to the UO group. While projected body mass index (BMI = weight÷height2, where weight is measured in kilograms, and height in meters), and likelihood of type I obesity (BMI ≥ 30), among UO females rises with the number of children, the opposite trend occurs for UO males. Consequently, in terms of likelihood to suffer from type I obesity as a prominent risk factor for health, an increase in the number of children tends to be detrimental to the health of UO females and beneficial to the health of the UO male. Research findings thus stress the importance of cultural differences among different religious groups and the need for cultural and gender-oriented health policies.

Rejecting “Controversial” Issues in Education: A Case Study of Ultra-Orthodox Jewish Schools in Belgium

In liberal democracies, fundamental rights and freedoms can conflict, and if they do, it is not always clear which right the state should prioritize. Should the right of parents to choose education in line with their own convictions prevail, or should the right of children to be prepared for a future life in a liberal democratic society be given more moral weight? While the former might lead to establishing and subsidizing orthodox religious schools, the latter implies “liberal”, “autonomy-facilitating” education. In order to make this tension concrete, we focus on a case study of an ultra-orthodox Jewish (Haredi) school in Flanders (Belgium), where “controversial issues” are excluded from the curriculum and where education is not fully in line with the core principles of “liberal education”. Subsequently, we explore the legal educational context in liberal democracies, with a particular focus on the freedom of religion and education. Then, we scrutinize several arguments for or against ultra-orthodox faith-based schools. We conclude that there are no convincing arguments for state support for these kinds of schools and that the recent Flemish policy of homeschooling might be a reasonable alternative, wherein a balance is found between children’s rights and parental rights.

Integration of Mixed Methods in Community-Based Participatory Research: Development of a Disease Prevention Intervention for Ultra-Orthodox Jewish Women.

To describe the development of the first disease prevention intervention with ultra-Orthodox Jewish (UOJ) women in Israel using mixed methods and community-based participatory research (CBPR). This collaborative, 7-staged development process used an exploratory sequential mixed methods design integrated into a community-based participatory approach. The UOJ community in Israel, a high-risk, low socioeconomic, culturally insular minority that practices strict adherence to religious standards, maintains determined seclusion from mainstream culture and preserves traditional practices including extreme modesty and separation between the sexes. Women from a targeted UOJ community in Israel with distinct geographic, religious, and cultural parameters. These included 5 key informant interviewees, 5 focus groups with 6 to 8 participants in each, a cluster randomized sample of 239 questionnaire respondents (an 87% response rate), and 11 steering committee participants. Qualitative data were analyzed through Interpretative Phenomenological Analysis by 2 researchers. Quantitative data were collected via questionnaire (designed based on qualitative findings) and analyzed utilizing descriptive statistics. Barriers to health behavior engagement and intervention preferences were identified. The final intervention included walking programs, health newsletters, community leader trainings, teacher and student trainings, and health integration into schools. Utilizing mixed methods in CBPR improved cultural tailoring, potentially serving as a model for intervention design in other difficult to access, low socioeconomic, and culturally insular populations.