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Background Parents in the Arab population of Israel are known to be “pro-vaccination” and vaccinate their children at higher rates than the Jewish population, specifically against human papilloma virus (HPV) and seasonal influenza. Objectives This study seeks to identify and compare variables associated with mothers’ uptake of two vaccinations, influenza and HPV, among different subgroups in Arab and Jewish society in Israel. Methods A cross-sectional study of the entire spectrum of the Israeli population was conducted using a stratified sample of Jewish mothers (n = 159) and Arab mothers (n = 534) from different subgroups: Muslim, Christian, Druse and Northern Bedouins. From March 30, 2019 through October 20, 2019, questionnaires were distributed manually to eighth grade pupils (13–14 years old) who had younger siblings in second (7–8 years old) or third (8–9 years old) grades. Results Arab mothers exhibited a higher rate of uptake for both vaccinations (p p = 0.0014, HPV – 46%; influenza – 34%). Furthermore, results showed that HPV vaccination uptake is significantly higher than seasonal influenza vaccination uptake in both populations. Examination of the different ethnic subgroups revealed differences in vaccination uptake. For both vaccinations, the Northern Bedouins exhibited the highest uptake rate of all the Arab subgroups (74%), followed by the Druse (74%) and Muslim groups (60%). The Christian Arab group exhibited the lowest uptake rate (46%). Moreover, the uptake rate among secular Jewish mothers was lower than in any of the Arab groups (38%), though higher than among religious/traditional Jewish mothers, who exhibited the lowest uptake rate (26%). A comparison of the variables associated with mothers’ vaccination uptake revealed differences between the ethnic subgroups. Moreover, the findings of the multiple logistic regression revealed the following to be the most significant factors in Arab mothers’ intake of both vaccinations: school-located vaccination and mothers’ perceived risk and perceived trust in the system and in the family physician. These variables are manifested differently in the different ethnic groups. Conclusions This research shows that all Arabs cannot be lumped together as one monolithic group in that they exhibit major differences according to religion, education and access to information. Ranking of variables associated with uptake of the two vaccines can provide decision-makers an empirical basis for tailoring appropriate and specific interventions to each subgroup to achieve the highest vaccine uptake rate possible. Media campaigns targeting the Arab population should be segmented to appeal to the various sub-groups according to their viewpoints, needs and health literacy.

Because public healthcare workers (HCWs) are at the forefront of the battle against COVID-19, they must be able to provide vaccination information to their patients and respond to their anxieties and concerns. This research objectives were to (1) examine physicians' perceptions of how they received information about the Pfizer COVID-19 vaccine, their attitudes toward hesitant colleagues, and their own knowledge and self-efficacy in communicating information to their patients, and (2) to examine the public's perceptions of physicians' knowledge when recommending the COVID-19 vaccine to their patients. At the beginning of the vaccination campaign, a survey examined the attitudes of physicians in the Israeli public healthcare system (n = 295) regarding the Pfizer vaccine. In addition, the attitudes of a representative sample (n = 500) of the Israeli adult population (age 18+) were examined through interviews. Most of the participating physicians (81%) reported they had already been vaccinated or intended to be vaccinated. When asked about their reasons for vaccine hesitancy, 27% cited concerns about long-term side effects and doubts about the vaccine's effectiveness in preventing contagion. They cited system pressure and departmental norms as explanations for their eventual compliance. Moreover, they saw the system as less tolerant of hesitant physicians, while they themselves tend to be more tolerant. The results of the survey of the public showed that mostly young people (under 44) who tend to be critical believe that physicians do not have sufficient knowledge to make recommendations about the COVID-19 vaccine. The findings indicate that the health system should employ complete transparency in conveying the advantages and disadvantages of the COVID-19 vaccine to physicians. The system should be more tolerant of physicians' worries and concerns and grant legitimacy to their reservations and misgivings. Moreover, medical studies should reinforce physicians' immunological knowledge regarding vaccinations so they can help their patients make informed decisions.

The literature indicates that trust plays an important role in people's decision-making with respect to vaccinations. This research seeks to examine the impact of trust on the high response rate to vaccinations among the minority Arab population living in Israel. The research employs the qualitative phenomenological research method, using personal interviews to identify and analyze perceived trust among mothers of young children and teenagers (n = 70) and among nurses (n = 20) in the Arab population in the context of vaccinations and the high response rate to vaccinations among this population. The research findings point to differing levels of trust in the medical system. The participants placed the highest trust in the nurses working in the Tipat Halav Family Health Centers run by the Ministry of Health. These nurses are the main communicators of information about childhood vaccinations in Israel. Moreover, the interviewees saw vaccinations as an example of the state offering equal and optimal services to the Arab minority population. In addition, the interviewees consider the explanatory materials to be limited, superficial and not culturally appropriate. These positive attitudes toward vaccinations alongside reports that no importance is attributed to the explanatory materials due to their low quality may cause the population to accept vaccination recommendations as they are and to delegate responsibility and authority to the state.

Background The issue of whether to include seasonal influenza vaccinations in school-located vaccination programs (SLIV) has been examined in many countries, mainly in the context of economic effectiveness and morbidity prevention. Yet not enough studies have examined the impact of parental risk perceptions, health literacy and SLIV on parental vaccination uptake. Objectives The most recent statistics in Israel point to a higher rate of seasonal influenza vaccination among Arab children (aged 7–9 years) than among Jewish children in the same age group. The present study attempts to explain this high vaccination uptake among mothers from Arab society by comparing their risk perceptions regarding seasonal influenza vaccination and disease to those of Jewish mothers. The study further examines the impact of SLIV on parental risk perceptions and influenza vaccination uptake. Methods This cross-sectional study included mothers of children in the second and third grades faced with the decision of whether their children should receive the seasonal influenza vaccination at school. The study population included a stratified sample of Jewish mothers (n = 159) and Arab mothers from all the Arab population sub-groups: Muslim, Christian, Druse and Bedouin (n = 534). Results A comparison of the Arab and Jewish populations revealed a significant difference in vaccination rates; 61.7% among Arab mothers compared to 33.5% among Jewish mothers (χ2(1) = 39.15, P Conclusion This study showed that the factors influencing vaccination uptake among both the Arab and the Jewish populations include perceived influenza risk, perceived vaccination risk, inclusion in the school-located vaccination program and health literacy. Moreover, influenza vaccination uptake is higher among those who have positive attitudes toward vaccinations, low risk perceptions regarding the vaccine, and low health literacy that impedes their ability to seek information. The research also points to the need for education and tools to boost health literacy among minority groups so that mothers can make independent and informed decisions about whether or not to vaccinate their children.

Past studies using the positive deviance (PD) approach in the field of infection prevention and control (IPC) have primarily focused on impacts on healthcare-associated infection rates. This research aimed to determine if health professionals who exhibit PD behaviours have distinctive socio-cognitive profiles compared to non-PD professionals, and to examine the impact of a PD intervention on healthcare professionals’ (HPs) behavioural changes in maintaining IPC guidelines. In a cross-sectional study among 135 HPs, respondents first filled out a socio-cognitive characteristics questionnaire, and after 5 months were requested to complete a self-reported behavioural change questionnaire. The main findings indicate that socio-cognitive variables such as external locus of control, perceived threat and social learning were significant predictors of a person exhibiting PD behaviours. Almost 70% of HPs reported behavioural change and creating social networks as a result of the PD intervention in maintaining IPC guidelines, 16.9% of them are a ‘PD boosters’ (a new group of HPs who have adopted the positive practices of PDs that were originally identified, and also added additional practices of their own). Social networks can contribute to internalizing and raising personal accountability even among non-PD professionals, by creating a mind map that makes each person believe they are an important node in the network, regardless of their status and role. Health intervention programmes should purposely make visible and prominent social network connections in the hospital system.

Background Healthcare workers (HCWs) are on the front line of the COVID-19 outbreak, and their constant exposure to infected patients and contaminated surfaces puts them at risk of acquiring and transmitting the infection. Therefore, they must employ protective measures. In practice, HCWs in Israel were not fully prepared for this sudden COVID-19 outbreak. This research aimed to identify and compare: (1) Israeli HCWs’ perceptions regarding the official COVID-19 guidelines’ applicability and their protective value, and (2) HCWs executives’ response to HWCs’ concern regarding personal protective equipment (PPE) shortage. Methods A mixed-methods sequential explanatory design consists of: (1) An online survey of 242 HCWs about the application of the guidelines and PPE, and (2) Personal interviews of 15 HCWs executives regarding PPE shortage and the measures they are taking to address it. Results A significant difference between the perceived applicability and protective value was found for most of the guidelines. Some of the guidelines were perceived as more applicable than protective (hand hygiene, signage at entrance, alcohol rub sanitizers at entrance, and mask for contact with symptomatic patients). Other were perceived as less applicable than protective (prohibited gathering of over 10 people, maintaining a distance of 2 m’, and remote services). Conclusions HCWs need the support of the healthcare authorities not only to provide missing equipment, but also to communicate the risk to them. Conveying the information with full transparency, while addressing the uncertainty element and engaging the HCWs in evaluating the guidelines, are critical for establishing trust.

Background Lifestyle change can be influenced through effective interaction between care receiver and care provider. The physical environment where the interaction occurs can affect the dynamics of long-term therapeutic treatment. There have been no studies on the perception of the physical environment in nutritional treatment. Objective Our aim was to ascertain the impact of the physical environment on the dynamics and communication between dietitian and patient based on perceptions of dietitians. Design We conducted qualitative constructivist phenomenological research. Participants In-depth interviews (n=10) and eight focus groups (n=62) were held with dietitians who offer treatment in a physical environment designed according to the medical model and/or in a physical dynamic environmental design according to the dynamic model. Results Most dietitians in Israel treat their patients in a physical environment arranged according to the medical model. The participants reported that the physical environment affects the interaction. However, the idea of transforming the physical environment according to the dynamic model raised reservations. Barriers include upsetting therapeutic boundaries, challenging professional authority, and lack of therapeutic tools suitable for the change. Conclusions Changes in the spatial design in which the therapeutic interaction occurs might support the dietitians' transformation from counseling into therapy. The barriers toward such change suggest that professional training is needed to enable dietitians to overcome them. We recommend conducting further research to evaluate the current physical environment, as well as raising dietitians' awareness and training them to work in the new environment, reflecting a counseling/therapeutic mindset. These changes should be followed by additional research among practitioners to report on their effects.

The present study examines reported pre-license driving among youth from the population of Arab citizens of Israel. The purpose of the present study is to examine which sociodemographic variables, attitudes and perceptions about safe driving and individual and societal behavioral norms are associated with pre-license driving. The research distinguished between the factors that actually contribute to pre-license driving (reported behavior, peer norms, gender and parents' messages) and the factors that explain the intention (parental authority, social norms, parents' messages and fear of road crashes). Even though there was a significant partial overlap (84%) between those who intend to drive without a license and those who reported driving without a license, the main factors that distinguish pre-license driving groups are different from the factors that distinguish the intention to drive before receiving a license. What is unique about the findings is the identification of the context in which social norms are influential and that in which parental authority is influential. The study indicated that in the case of pre-license driving, the main motivating factor is subjective norms, whereas in the case of expecting to drive without a license, the main motivating factor is the interaction between parental authority and the messages that parents convey. While actual behavior pertains to the behavioral level, we argue that intended behavior pertains to the cognitive level. At this level, rational considerations arise, such as fear of parental punishment and fear of accidents. These considerations compete with the influence of friends and their norms, and may outweigh them. The findings suggest that it is important to safeguard youth against the influence of peer pressure as early as the stage of behavioral intentions. Follow-up studies can simulate situations of pre-license driving due to social pressure and identify the factors that might affect young people's decision-making. Moreover, providing parents with training before the accompaniment period is highly recommended.

Background Sports dietary supplements are available for sale in public places including sports clubs. Although there is uncertainty regarding their safety, many gym members who regularly work out consume them. The present study aimed to identify the approaches and perspectives of the public who work out in gyms and take dietary supplements. It examined how professionals view sports dietary supplement consumption, and how they communicate this issue to gym members. The literature discusses the prevalence of SDS use among athletes, but rarely discusses or compares between the risk perceptions of gym members, trainers, and dietitians, who represent the physically-active general public, regarding SDS. Methods We conducted constructivist qualitative research in semi-structured one-on-one interviews (n = 34). We held in-depth interviews (n = 20) with a heterogeneous population of adult gym members who take dietary supplements, and (n = 14) with dietitians and fitness trainers. Results The main finding was a gap in risk perception of dietary supplement use between dietitians, gym members and fitness trainers. There was low risk perception among dietary supplements consumers. Trainers believed that benefits of supplement consumption exceeded risk, and therefore they did not convey a message to their clients about risk. In contrast, dietitians interviewed for this study renounced general use of sports dietary supplements and doubted whether trainers had proper nutritional knowledge to support it. Conclusion Lack of awareness of risks suggests that there is a need for communication on this issue. We recommend that professionals (physicians and dietitians) be present in sports clubs that sell such products in an uncontrolled way.

Background:Despite the significant improvement in all components of preparedness in the past decade, there are still gaps between the guidelines and the reality on the ground. The purpose of this study is to explore how Israeli public health and emergency medicine experts perceive the demands for health organization emergency preparedness and the actual practice.Methods:Qualitative phenomenological research. We interviewed 22 Israeli public health and emergency medicine experts face-to-face and conducted a content analysis.Results:The findings revealed barriers in the following areas: preparation and readiness of hospitals, preparedness and readiness in the community, connection between the community and the hospital, inter-agency coordination and interface, interdisciplinary integration, preparedness resources, postcrisis evaluation, assimilating smart technologies, information accessibility, and communication.Conclusions:To reduce the gap between theory and practice, retrospective research and evaluation must be included to learn in depth what strategies and resources should be used during a health crisis. Likewise, profiles should be constructed and the community should be segmented in order to design resilience programs and accommodate information to subpopulations.

Background Despite World Health Organization recommendations that patients should play a role in encouraging hand hygiene (HH) as a means of preventing infection, patient engagement remains an underused method. From the perspectives of hospitalized patients (HPs) and health care workers (HCWs) at 2 major public hospitals in Haifa, Israel, this research investigated (1) HP barriers to reminding HCWs to maintain HH, (2) HCW barriers to giving HPs instruction on proper hygiene, (3) what could help HPs and HCWs overcome these barriers, and (4) how video clips can be used to devise tailored strategies governing discourse on HH between HCWs and HPs. Methods Intervention type 2 design and examination of 2 population groups—HPs and HCWs—before and after intervention by means of mixed methods research. Results Both HPs and HCWs reported partial knowledge, embarrassment, and fears regarding commenting to staff, as well as a lack of cultural adaptation. The interviewees indicated that the video clips granted legitimacy to reminding HCWs about hygiene through strategies designed to identify and solve barriers, authenticity, and cultural adaptation. Conclusions To overcome HP and HCW barriers to maintaining HH, tailored video clips on HH should specify barriers and solutions with which they can both identify, thus turning discourse on HH into an accepted norm.

Background There has been a steady rise in the use of medication by Israeli school children to treat ADHD, partly due to what seems like school teachers’ and counselors’ tendency to express positive attitudes towards its use. Therfore it is important to examine the involvement of the school teachers and counselors in the parents’ decision-making about giving their children medication. Methods This study used a qualitative constructivist research method of semi-structured interviews. It included individual interviews with 36 teachers and school counselors and 11 parents of students ages 9–14 from the Jewish and Arab populations. Results Teachers and school counselors use different strategies to encourage parents to have their children diagnosed for ADHD and medicated. First they suggest diagnosis as a necessary step in the best interest of the child, distinguishing between diagnosis and medication to mitigate parents’ concerns. In the second stage, teachers normalize the use of medication, as well as framing it as a drug that provides not only a medical treatment but also emotional wellbeing. Conclusions Teachers and counselors are involved in parents’ decision-making process about medicating their children to treat ADHD, which contradicts the education system’s guidelines. It is necessary to set clear and explicit limits and guidelines for education system employees so that they do not cross professional and ethical limits.

Background A major earthquake in Israel is inevitable. Individual risk perceptions and preparedness can mitigate harm and save lives. The gap between the public’s concerns and those of experts is reflected in their differential perceptions regarding the components that influence the occurrence of an earthquake in Israel. Whereas the public believes that geographic location is the critical variable, the experts note additional variables that need to be considered. Common knowledge regarding the risks of earthquake occurrence in Israel is based on a distinction between high and low-risk areas, such that the closer a residential area is to the Great Rift Valley, the higher the risk that an earthquake will occur. Objectives To examine the variables affecting public preparedness in Israel (effective communication agent (communicator), high and low earthquake risk areas) and the degree to which experts’ knowledge contradicts respondents’ common knowledge. Methods The study used a mixed-methods approach combining qualitative and quantitative research. The first stage included in-depth interviews with earthquake experts (n = 19). The second stage consisted of an experiment conducted among a representative sample of the public (n = 834). Results Most people believe that geographical location constitutes the main risk factor for earthquakes in Israel. Yet experts claim that additional variables affect earthquake intensity and damage: building strength, earthquake magnitude, distance from earthquake epicenter, soil type, and interaction between these four. The study found that knowledge of expert information affects public willingness to prepare. The direction of this influence depends on participants’ risk perceptions regarding residential area and on degree of consistency with common knowledge. In low-risk areas, added knowledge increased willingness to prepare whereas in high-risk areas this knowledge decreased willingness. Conclusion To turn expert information into common knowledge and to increase earthquake preparedness, the authorities must educate the public to generate a new public preparedness norm.

The current research focuses on the 2013 polio outbreak in Israel as a case study to analyze the sources of information used in new media platforms, examining whether the new media have changed the ways in which we communicate about health issues. Specifically, we tracked and coded polio-related references on Hebrew news websites, blogs, forums, and Facebook posts. Overall, 24,388 polio-related references constituted our sampling frame. The findings suggest that there is a moderate-level correlation between the platform and the type of sources chosen by users. Beyond the differences between various platforms, we found that online information platforms rely not only on popular or pseudoscientific sources, but also on high-quality information. In fact, the analysis indicates that online news websites, forums, blogs, and Facebook posts create a unique blend of information, including scientific literature, medical professionals, and government representatives, as well as pseudoscientific research. These findings suggest a more optimistic view of the Internet as a source for health-related information in times of crises. Although the fact that members of the public are exposed to scientific sources does not indicate to what degree this affects their actual decision making. Exposure to a wider variety of sources may enhance health literacy, resulting in a better understanding of information needed to make informed decisions.

This study focuses on the process of the integration of Arab Muslim Israelis suffering from mental disorders into the normative community, addressing perspectives of both people with mental disorders and the community. This qualitative-constructivist study seeks to understand the dynamics of face-to-face meetings by highlighting the participants' points of view. The main themes of the findings included stereotypes and prejudices, gender discrimination, and the effect of face-to-face meetings on integration of people with mental disorders (PMD) into the community. The findings support former studies about the integration of PMD into the normative community, but add a unique finding that females suffer from double discrimination: both as women in a conservative society and as PMD. The study findings indicate a perception of lack of self-efficacy of PMD as a key barrier preventing integration into the community, which also prevents community members and counselors from accepting them or treating them as equals. We recommend on a social marketing campaign to be undertaken with the Arab Muslim community to refute stigmas and prejudices, particulary with double gender discrimination suffered by women with mental disorders in the Muslim community and training of community center counselors who have contact with the PMD population.

Background On March 11, 2020, the World Health Organization (WHO) officially declared coronavirus disease (COVID-19) to be a pandemic. This posed challenges to many countries, prominent among which is communication with the public to gain their cooperation. Israel faces different challenges from other countries in its management of the COVID-19 crisis because it is in the midst of a deep constitutional crisis. Objective The objective of this paper was to examine the response of the Israeli public to the government’s emergency instructions regarding the pandemic in terms of correlations between overall risk perception and crisis management; overall risk perception and economic threat perception; crisis management and compliance with behavioral guidelines; and crisis management and economic threat perception. We also made comparisons between crisis management and spokesperson credibility and between crisis management and the credibility of information sources. Methods The sample was established using an online survey that enabled rapid and effective distribution of an online questionnaire during the COVID-19 crisis. The self-selection online survey method of nonprobability sampling was used to recruit participants (N=1056) through social network posts asking the general public (aged ≥18 years) to answer the survey. Results Participants aged ≥65 years perceived higher personal risk compared to those aged 18-30 years (mean difference 0.33, 95% CI 0.04-0.61) and those aged 46-64 years (mean difference 0.38, 95% CI 0.12-0.64). Significant correlations were found between overall risk perception and attitudes toward crisis management (r=0.19, P Conclusions The higher the public trust and evaluation of crisis management, the greater the compliance of the public with guidelines. It was also found that crisis management and information cannot be approached in the same way for the overall public. Furthermore, unlike other epidemics, the COVID-19 crisis has widespread economic and social consequences; therefore, it is impossible to focus only on health risks without communicating economic and social risks as well.

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Despite a proven association between the implementation of prevention guidelines for central line associated blood stream infections (CLABSI) and reduction in CLABSI rates, in practice there is poor adherence. Furthermore, current guidelines fail to address the multiple process on the care continuum. This research is based on the bottom-up "Positive Deviance" (PD) approach, through which multiple creative and safer solutions for central line (CL) insertion were identified that were not previously described in the guidelines. The aim of the study was to deconstruct CLABSI prevention guidelines ("during insertion" process only) through the PD approach, working with physicians to identify additional actions that, in practice, help maintain a sterile environment and contribute to patient safety. Our study included a qualitative ethnographic study involving 76 physicians, working in a division of internal medicine and two intensive care units (ICUs). We triangulated findings from a combination of data-collection methods: semi-structured interviews, focused observations, video documentation, Discovery & Action Dialogue (DAD), and simulations. Deconstruction analysis was performed. A total of 23 creative extensions and variations of CL insertion practices were identified. The PD approach enables the identification of vital nuggets of hidden wisdom missing from the formal explicit CLABSI guidelines, and therefore helps bridge the gap between theory and praxis. During the guideline’s deconstruction process, through collaborative staff learning, the written procedure is transformed into a living, breathing and cooperative one. It can reduce hospital stays and save lives, and therefore needs careful attention of healthcare scholars and practitioners.

This study addresses the issue of valence framing effect in the context of immunization, a preventive behavior often addressed by the equation of benefit versus risk. The authors examined how framing (support vs. oppose) the issue of HPV vaccination in Israel's immunization routine affects attitudes regarding vaccine regulations. The study also examined issue involvement as a moderator of valence framing effect. The results demonstrate that participants in the positive framing condition tended to express greater support for voluntary immunization than participants in the negative framing condition (77.5% and 48.5%, respectively). Among those who supported the mandatory HPV immunization policy, the negative framing condition was more prominent than the positive condition (51.5% and 22.5%, respectively). The analysis of interaction between valence framing and issue involvement showed that the latter tends to moderate the direct effect of framing on attitudes towards vaccination. Findings indicate that even attitudes towards such consequential preventive behaviors as vaccination could be affected by different framing of the issue, especially for those who are less involved. Implications of predilection for freedom of choice regarding vaccination are also discussed.

Background The developing fetus is susceptible to environmental insults. Studying the effects of environmental exposures on fetal growth is essential for understanding the causal pathway between prenatal exposures and pregnancy outcomes. Here we describe the Haifa Pregnancy Cohort Study (HPCS) and discuss challenges and opportunities in applying “big data” paradigm. Methods Maccabi Healthcare Services (MHS), is the second largest Israeli health maintenance organization (HMO) providing care services to two million beneficiaries. The HPCS cohort potentially includes ~750,000 newborns born between 1998 and 2017. We will estimate daily exposures to air pollutants, temperature and greenness, using satellite-based data and models. We hypothesize that residents of Haifa have higher exposures to environmental pollutants and that in pregnant women this higher exposure is associated with poorer fetal growth. We will evaluate outcomes such as birth-weight, head-circumference and gestational age at birth. We will adjust for pregnancy complications such as pre-eclampsia and gestational diabetes and parental variables, such as maternal weight, age and smoking habits as potential confounders. In addition, we will conduct a multi-tiered field study, nested within this population, among 150 pregnant women residing in two geographical regions-one in the polluted Haifa area, and one in a relatively unpolluted area in central Israel. Blood and urinary samples will be collected, as well as personal and indoor exposure to air pollution. Discussion Evaluating environmental exposures of pregnant women and assessing in utero growth over the course of the pregnancy during different exposure windows, is of great scientific and public health interest. Recent advances in data collection and analysis pose great promise to provide insights into contribution of environment to the health of the developing fetus, but also pose major challenges and pitfalls, such as data management, proper statistical framework and integration of data in the population-based study and selectiveness in the nested field study. Yet the continuing follow-up of the study cohort, integrating data from different services, health-promotion, and eventually, application later in real life of our main promises. Our study aims to meet these challenges and to provide evidence of the environmental exposures associated with fetal growth.

Background During epidemic crises, some of the information the public receives on social media is misinformation. Health organizations are required to respond and correct the information to gain the public’s trust and influence it to follow the recommended instructions. Objectives (1) To examine ways for health organizations to correct misinformation concerning the measles vaccination on social networks for two groups: pro-vaccination and hesitant; (2) To examine the types of reactions of two subgroups (pro-vaccination, hesitant) to misinformation correction; and (3) To examine the effect of misinformation correction on these two subgroups regarding reliability, satisfaction, self-efficacy and intentions. Methods A controlled experiment with participants divided randomly into two conditions. In both experiment conditions a dilemma was presented as to sending a child to kindergarten, followed by an identical Facebook post voicing the children mothers’ concerns. In the third stage the correction by the health organization is presented differently in two conditions: Condition 1 –common information correction, and Condition 2 –recommended (theory-based) information correction, mainly communicating information transparently and addressing the public’s concerns. The study included (n = 243) graduate students from the Faculty of Social Welfare and Health Sciences at Haifa University. Results A statistically significant difference was found in the reliability level attributed to information correction by the Health Ministry between the Control condition and Experimental condition (sig

Edutainment is a communication strategy to influence attitudes and behaviors through the use of the media. Through the children’s play “Yael Learns to Take Care of Her Body,” designed for joint viewing by children aged 5–8 and their parents, sexual abuse is raised. This qualitative study findings indicate that parents from low socioeconomic subgroups from the secular sector reported that their awareness had been raised by viewing the play and that they received tools for holding a conversation. Conversely, parents from high socioeconomic subgroups in the secular sector and parents from the national-religious sector were more ambivalent regarding the play’s effectiveness. In order to make the conversation meaningful, the play has to tailor different messages to different audiences. A single program is not enough but should be part of a series of customized intervention programs for different subpopulations and separate programs for parents and children accompanied by professionals.

Background: Designing web-based informational materials regarding the human papillomavirus (HPV) vaccine has become a challenge for designers and decision makers in the health authorities because of the scientific and public controversy regarding the vaccine’s safety and effectiveness and the sexual and moral concerns related to its use. Objective: The study aimed to investigate how cultural sensitivity (CS) is articulated in the explanatory informational materials on the HPV vaccine that are posted on the websites of the Israeli health authorities. In addition, the study examined the effect of transparency on the expression of CS in the informational materials. Methods: The study employed a quantitative and qualitative content analysis of the texts of explanatory informational materials published on the Arabic and Hebrew websites of the Israel Ministry of Health and the Clalit health maintenance organization (HMO). Results: The findings revealed the differences in the dimensions of CS (based on the CS model by Resnicow) between the informational materials targeting the majority Jewish population and those targeting the minority Arab population. Indeed, the research findings point to a paradox. On the one hand, the materials appealing to the conservative Arab population exhibited CS, in that the sexual context of the vaccine was missing. On the other hand, analysis of Resnicow's deep dimensions showed that disregarding the sexual context does not allow the relevant target audience to reflect on the barriers and concerns. In addition, the way the information was provided exhibited a lack of transparency regarding the CS dimensions (surface and deep). Conclusions: The public health authorities have 2 main objectives in the context of vaccinations. One is to raise the vaccination rates and the other is to provide full and culturally sensitive information to give the public the tools to make intelligent decisions. The findings of this study indicated that despite the high uptake rate for HPV vaccination in the Arab population, the health authorities did not exercise full transparency and CS in transmitting the association between engaging in sexual relations and the necessity of the vaccination. Thus, the major challenge for the health authorities is to find ways to implement the objective of communicating information about the vaccination in a way that is transparent and culturally sensitive, even if this raises questions and fears among the public deriving from their culture.

The emergence of the avian influenza A (H7N9) in China during 2013 illustrates the importance of health care professionals as a mediating channel between health agencies and the public. Our study examined health care professionals' risk perceptions considering their unique position as representing the health care system and yet also being part of the public, hence a risk group. Recent studies have examined the role of health professionals' personal risk perceptions and attitudes regarding compliance of the general public with vaccination. Our study examined how risk perception affects their risk analysis.We employed an online survey of Israeli health care professionals and the general public in Israel (N = 240).When risk perception is relatively low, health care professionals tend to base their attitudes toward vaccines on analytical knowledge (Rc = 0.315; P.05), whereas in situations with high risk perception, the results did not indicate any significant difference between Israeli health professionals and the Israeli general public, hence both groups base their attitudes more on emotions and personal experience than on analytical knowledge.Public health organizations must consider the fact that health professionals are a group that cannot be automatically treated as an extension of the organization. When the risk is tangible and relevant, health care workers behave and act like everybody else. Our study contributes to understanding health care professionals' perceptions about vaccines and the thinking processes underlying such perceptions.

Nutritional labeling helps consumers make healthier choices regarding food product purchases. In this study, we examined the difference between immigrants from the former Soviet Union who emigrated to Israel beginning in 1990 (IIFSU) and the general population of Israel regarding food consumption broadly and the use of nutritional labeling specifically. A representative sample of each population (n = 592) was composed and interviewed. According to the findings, compared to the general population, the IIFSU attribute less importance to health factors in purchasing food products and information about the ingredients contained in food products; they tend not to follow nutritional labels; and report less on the need for nutritional integrative labeling. Following from this, in the second part of the study, we investigated which of the socio-economic variables is most dominant in shaping attitudes towards food consumption and nutritional labeling. Only immigration and age were found in correlation with attitudes related to healthy food consumption. In contrast, gender, education and religious observance did not affect food selection. Immigration was recognized as the main factor with more clout than the other variables. In conclusion, it is crucial to clarify immigrants' perceptions of the concept of "health" and "proper nutrition" in formulating health promotion programs.

Knowing about one's health rights can be critical for obtaining equitable and appropriate health care. A model drawing on a culture-centered approach was used to develop and present health rights information materials for a disadvantaged cultural minority-the Ethiopian immigrant community in Israel. The model is based on the supposition that the design of health rights information materials should address both concerns and barriers identified by members of the cultural community and illustrate specific means to address them. Stories of community members' actual experiences served as the basis for several types of narratives presented in video clips, a photonovella, and an illustrated booklet. More than 100 people participated in the study in five focus groups and 50 personal interviews. Findings indicate participants felt the materials developed using this approach were informative and represented their concerns and cultural barriers to realizing these rights from their perspective and would help motivate them to realize their health rights. The analytic process, which involved members from the cultural community, resulted in the identification of dilemmas associated with the development of solution-oriented materials that draw on the culture-centered approach. These dilemmas pose additional theoretical challenges to the culture-centered approach.

Background Based on the Social Marketing approach and Diffusion of Innovations Theory that indicates the importance of opinion leaders with respect to the spreading of new ideas, concepts or practices within a community, the present study aimed to examine positions and perceptions of Israeli leading dietitians and health officials regarding nutrition labelling and the Choices logo, before it was launched in Israel in February 2011, as well as how they would communicate it to the public as agents of influence. Methods The study involved in-depth face-to-face and telephone interviews with 15 senior dietitians and Health Ministry officials using semi-structured protocols including questions about nutrition labelling and the Choices logo. Results The respondents considered that the nutrition facts panels usually found on the backs of packages are too complicated for the average consumer. Simiularly, fronts of packages are cluttered with advertisements and health claims, causing confusion. The study participants would like to see an integrative label on the front of the package to facilitate consumers' decisions. However, the Choices logo raises ethical and social questions about the conflict between corporate interests and public health: (i) the label's relativity versus objectivity; (ii) the consumer's responsibility to create a balanced diet; (iii) the label's credibility; and (iv) bias against companies, products and audiences. Conclusions The results of the present study highlight the importance of a need for an integrated programme of nutrition promotion, including the use of social marketing based on a cooperative effort between the food industry, regulators and professionals, to recommend changes and adjustments in nutritional front of package labelling with the aim of promoting healthier nutrition consumption.

Subjective drunkenness measures may be useful screening tools for alcohol-related problems. However, if self-reported drunkenness is influenced by social and cultural understandings, the measure may not predict drinking patterns equally across different sociocultural groups. The current study aims to determine whether the two main sociocultural groups in Israel (Arabs and Jews) are equally likely to report drunkenness at comparable levels of breath alcohol content (BrAC).A cross-sectional study was conducted among 901 Jewish and 225 Arab Israeli pub patrons. Respondents were interviewed as they exited pubs between midnight and 4 am. In addition to sociodemographic data, respondents reported whether they felt drunk at the time of the interview, after which they provided breath samples to determine BrAC. A logistic regression model tested whether there were differences in the probability of reporting drunkenness between Arabs and Jews holding BrAC levels and other background variables constant.Arabs had higher BrAC levels than Jews (M = 0.19 vs. M = 0.13, P ≤ 0.0001) but a lower proportion of Arabs reported drunkenness than Jews (22% vs. 43%). Adjusted logistic regression showed that at all levels of BrAC, Jews had a higher probability of reporting drunkenness than Arabs (odds ratio = 6.40, P ≤ 0.0001).Subjective drunkenness is likely to be influenced by cultural factors and may thus not reflect objective drinking patterns equally across different groups within the same society. This is likely to limit its usefulness as a screening tool for alcohol abuse and problems. [Sznitman SR, Bord S, Elias W, Gesser-Edelsburg A, Shiftan Y, Baron-Epel O. Examining the sociocultural sensitivity of subjective drunkenness: Comparing Arab and Jewish Israeli pub patrons.

A new policy recently enacted in Israel promises preferred status in receiving organs for transplantation to individuals who register to be organ donors and to their close family members. Proponents believe it will increase the supply of organs for transplantation from the deceased. Ethical issues were raised in government committees appointed to discuss the policy before its approval, but discussions among laypeople were not solicited. This study aimed to elicit laypeople's views about the policy by conducting thirteen group interviews and thirty-six individual interviews. Participants included religious and nonreligious people, immigrants, and Arabs. Some participants thought the law would contribute to fairness by prioritizing those willing to give, but others articulated ethical concerns that were not emphasized by scholars, in particular that the policy would add to the erosion of social solidarity, increase divisiveness, and enable people to abuse the system. Mistrust in the health care system emerged as a prominent reason for not registering as an organ donor. Implications about the importance of transparency in the organ transplantation system as a basis for an information campaign, social norms regarding organ donation, and the public's involvement in policy issues on organ donation are discussed.

The unexpected developments surrounding the Ebola virus in the United States provide yet another warning that we need to establish communication preparedness. This study examines what the Israeli public knew about Ebola after the initial stages of the outbreak in a country to which Ebola has not spread and assesses the association between knowledge versus worries and concerns about contracting Ebola.Online survey using Google Docs (Google, Mountain View, CA) of Israeli health care professionals and the general public (N = 327).The Israeli public has knowledge about Ebola (mean ± SD, 4.18 ± 0.83), despite the fact that the disease has not spread to Israel. No statistically significant difference was found between health care workers versus non-health care workers in the knowledge score. Additionally, no statistically significant association was found between knowledge and worry levels. The survey indicated that Israelis expect information about Ebola from the health ministry, including topics of uncertainty. More than half of the participants thought the information provided by the health ministry on Ebola and Ebola prevention was insufficient (50.5% and 56.4%, respectively), and almost half (45.2% and 41.1%, respectively) were unsure if the information was sufficient.The greatest challenges that the organizations face is not only to convey knowledge, but also to find ways to convey comprehensive information that reflects uncertainty and empowers the public to make fact-based decisions about health.

The Israeli society is a unique setting in which the Arabs are exposed to western alcohol consumption norms while living in Arab communities where alcohol consumption is not accepted.To characterize Arab Muslim, Druze and Christian alcohol consumption behaviors and contingencies while being exposed to western style alcohol consumption.This study was a phenomenological qualitative study interviewing six focus groups and 13 individual Arab Muslims, Christians and Druze. Themes and categories were identified using qualitative methodology analysis.Two concurrent contingencies exist for Arab Muslim men: on the one hand they describe pressure to drink because of social norms, and on the other hand they are reprehended for drinking, because of the religious interdiction. Therefore, they hide their drinking in secluded places. In addition, participants reported more heavy drinking among Muslim Men. Arab Christians reported drinking openly especially among men. Women do not drink and are looked down upon if they drink. Drinking may be viewed as a stage in life that a Muslim boy or young man goes through, he is expected to grow out of this stage and stop drinking while becoming religious. Conclusions/importance: Due to Muslim laws prohibiting alcohol consumption, alcohol consumption is not high, however it does exist especially among young men and when they drink they tend to drink heavily, more than the Arab Christians. Therefore, there is a need for interventions targeting younger Muslim men, to establish moderate drinking behaviors, if they chose to drink.

Worldwide there is a dearth of studies examining drinking patterns in Arabs and how these compare to other populations. The few studies that exist have suggested distinct drinking patterns in Arabs, with not only high rates of abstinence but also high rates of heavy drinking among current drinkers. No studies have yet examined potential socio-cognitive mechanisms that may contribute to this distinct drinking pattern. Israel represents a unique and valuable resource for studying Arab population drinking patterns because Israeli Arabs are nonimmigrants living in areas where exposure to Western lifestyles, including alcohol consumption, is prevalent. The current study was set out to examine differences in alcohol consumption in a convenience sample of 1310 Jewish and Arab students from Israeli universities and colleges and to explore alcohol expectancies as potential mediators of ethno-religious differences.Logistic regressions were used to produce odds ratios and 95% confidence intervals to test differences between Jewish and Arab students on binary outcomes (lifetime, last month, and heavy drinking). Mediation of ethno-religious differences by alcohol expectancies was tested with bootstrapping procedures.Results show that while Israeli Arab students tend to be more likely to abstain from alcohol than Israeli Jewish students, among current drinkers, Israeli Arab students are at a particular high risk of heavy drinking. Results also show that this is partly mediated by the expectancy that alcohol only influences the drinker at high levels of intake.The current study confirms distinct Arab drinking patterns found in previous studies. The present study is the first demonstration that drinking expectations mediate ethno-religious differences in heavy drinking among Israeli Arabs and Jews. This work contributes to the understanding of ethno-religious group differences in harmful drinking, potentially informing future etiologic research and public health interventions aimed at reducing alcohol-related harm.

The successful use of drama as a vehicle to influence health-related attitudes and behaviors is credited to its ability to elicit an emotional experience and identification among audience members. This study investigated the views of adolescents regarding an entertainment-education (EE) component of their school's anti-drug program - a live performance of a professionally produced anti-drug abuse drama. The analysis draws mainly on data collected from 64 focus groups, conducted in 24 schools across Israel, and open-ended responses to questionnaires administered to more than 1,700 adolescents. The adolescents were generally entertained by the anti-drug abuse drama and moved by its "authenticity," which emerged as a central construct in this study. Yet only a fraction identified with the characters and many remained unwilling to "tell" on a friend who uses drugs. Drawing on these findings, implications to EE theory and practice are discussed, particularly as they relate to the drama's perceived realism or "authenticity," and its unintended effects.