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Background: Between 1948 and 2020, Palestinians living in Israel have seen an 11-times increase in population density. Palestinian citizens of Israel (PCI) comprise 20% of the population, restricted to living in 2·7% of the land. The effects of the resulting overcrowding are spatial, political, cultural, economic, and administrative and are also associated with intracommunal crime and violence. Between 2000-17, from 122 annual homicide cases in Israel, 79 (65%) victims were PCI. Palestinians have a 5·5 times higher risk of dying from homicide than Jewish citizens of Israel. 2021 saw a peak in homicide rates, where 126 (74%) of the 170 homicide cases in Israel were among PCI. 83% of homicides among PCI were a result of gunshots, with more than 400 000 illegal firearms estimated to circulate among the Palestinian community in Israel. Yet, only 23% of homicide cases among PCI were solved by the police compared with 73% of cases among Jewish citizens of Israel. This study examines the attitudes of PCI towards violence, crime, safety, and trust in the Israeli police.Methods: We did a cross-sectional study; the survey form included demographic data and questions about exposure and attitudes towards safety, violence, crime, and the police and government handling of crime. Participants were all PCI living in Palestinian towns and in mixed cities in Palestinian neighbourhoods. Participants were randomly chosen from 68 towns, and conducted in private homes by trained surveyors. The study sample was a stratified multi-stage random sample, divided into four levels of stratification: region (north, centre, or south of Israel), community size (small [<5000], medium [5000-15 000], or large [>15 000]), locality classification (cities or villages), and locality type (recognised and unrecognised as official towns by the state). The main outcomes assessed were participant perceptions of the prevalence in violence among PCI and the authorities' commitment to curb it. The Galilee Society Ethics Committee approved the study and informed consent was obtained from all participants.Findings: Interviews were done in 2040 households housing 7985 family members, recruited and interviewed in 2018. Personal interviews were conducted with one person per family. Of these 2040 interviews, 1970 interviews were included in the analysis. 1283 (65·1%) of 1970 participants estimated the prevalence of violence as being high or moderate in their towns. 958 (48·6%) participants estimated that violence has increased in their town during the past year. 1062 (53·9%) participants that they could be a possible target of violence. 1027 (52·1%) participants reported that crime is the biggest problem that the Palestinian community in Israel faces, followed by racist laws (436 [22·1%]) and the difficult economic situation (282 [14·3%]). 1474 (74·8%) participants reported that the use of weapons has become normal in everyday disputes. 1496 (75·9%) reported that the state is interested in the spread of violence in the Palestinian towns in Israel. 1728 (87·7%) participants stated that an absence of governmental interest in addressing the problem of unauthorised weapons is the cause of their spread, and 1634 (82·9%) participants stated that police complicity is a cause of the spread of unauthorised weapons. 1411 (71·6%) participants disagreed with the statement that the Israeli police deals with violence seriously.Interpretation: PCI perceive a high exposure to violence within their communities, with most participants reporting that communal violence is linked to the Israeli government and police being disinterested in addressing the problem, and the complicity of the Israeli police (which reflects a mistrust in the Israeli government and police force, and that crime among PCI becomes a justification to further criminalise, stigmatise, and police these communities). Given that violence, crime, and homicide are major causes of morbidity and mortality and thus urgent public health problems, every effort should be made to advocate for addressing these problems among PCI, especially among medical and health-care communities.Funding: Galilee Society and Palestinian Central Bureau of Statistics. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the trend of consanguineous marriage among the Arab population in Israel. Socio-demographic data for the Arab population were extracted from national health surveys conducted in Israel in 2007 and 2017. The prevalence of consanguineous marriage among the Arab population in Israel increased significantly from 36.3% to 41.6% in the decade from 2007 to 2017. First-cousin and closer marriages constituted about 50% of total consanguineous marriages in the two periods surveyed. Consanguinity was found to be significantly related to religion and place of residence. Thus, the prevalence of consanguineous marriage remains high among the Arab population in Israel, similar to other Arab societies. These findings affect the health of future generations and impose a challenge for health care professionals. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the prevalence and trends of various types of consanguineous marriage among the Arab community in Israel over a long time period (1948-2007) by religion and educational level. Data were collected by face-to-face interview of 3173 Arab couples living in Israel in 2007 and 2008. The trend in consanguineous marriages was found to decrease significantly over successive time periods, from 42.5% to 30.9% (p=0.001), and the prevalence of first-cousin and closer marriages decreased, from 23% to 12.7%. Consanguinity was found to be significantly related to religion (p=0.001) and wife's level of education (p=0.028). [ABSTRACT FROM AUTHOR]

Background: The role of residential segregation and spatial separation of population groups along racial or ethnic lines is well documented as a factor contributing to health disparities, such as rates of homicide and crime in African Americans. Most of the two million Palestinian citizens in Israel live in segregated, exclusively Palestinian towns, whereas approximately 132 000 live in mixed Jewish Palestinian cities that were Palestinian cities before the Palestinian exodus, in 1948, when most inhabitants were expelled, turning the Palestinians who remained into a minority. Despite having higher employment rates, Palestinians in so-called mixed cities live in enclaves with higher poverty, poorer educational facilities, and more intracommunal crime than Palestinian communities in segregated towns. The aim of this study was to assess the prevalence of trust in the Israeli government and in police commitment in crime fighting among Palestinian citizens in Israel in different towns.Methods: Data were collected in 2018 using a stratified multistage random sample of 2040 households (n=7985 adults). A scale was computed measuring reports on trust in the government and in the police's commitment in curbing crime (Cronbach's α=0·92). Bivariate analyses were done to test for significant associations between the dependent variable of trust in police or government and associated factors. Binary logistic regression was done to check for confounders. The Galilee Society Ethics Committee approved the study.Findings: Participants living in mixed cities were more likely to report high levels of violence in their communities (OR 4·3, P=0·001) and were less likely to trust the police or the government in curbing crime (odds ratio [OR] 0·32 [95% CI 0·19-0·54]; p<0·05) than participants in segregated towns. Compared with participants older than 35 years, younger people were more likely to trust the police or government (1·39 [1·12-1·72]; p<0·05). Muslims were less likely to trust the police or government than Druze and Christians (0·51 [0·35-0·75]; p<0·05). Those living in communities unrecognised by the Israeli government were less likely to trust the police or government than those living in recognised communities (0·33 [0·22-0·49]; p<0·05). Those living in large towns (ie, with more than 15 000 inhabitants) and medium-sized towns (with populations of 5000-15 000) were less likely to trust the police or the government (OR 0·47 [95% CI 0·34-0·66]; p<0·05 for inhabitants of large towns and 0·65 [0·46-0·91]; p<0·05 for inhabitants of medium-sized towns) than people living in small-size towns (ie, with less than 5000 inhabitants). Those unable to cover daily expenses were less likely to trust the police or the government to control crime than those who could cover daily expenses (OR 0·68 [95% CI 0·55-0·85]; p<0·05). Other variables were not significant.Interpretation: Palestinians living in mixed cities view their environment as more violent and have less trust in the government or police's commitment to fight crime. A pattern of urban segregation with urban violence and breakage of social cohesion that is spatially expressed as urban enclaves or so-called purified localities has been used to describe the Palestinian lived experience in mixed cities, and might contribute to worse public health effects than completely segregated Palestinian towns. The lived experience of mixed and segregated livelihood for Palestinian citizens in Israel is substantially different from that of African Americans in the USA, and requires further research. Because violence, crime, and homicide are important public health problems, every effort should be made to measure the prevalence of crime in various communities and uncover its underlying causes so that crime can be effectively reduced.Funding: The research was funded by the Galilee Society and the Palestinian Central Bureau of Statistics. [ABSTRACT FROM AUTHOR]

Background: Hookah smoking is a common activity around the world and has recently become a trend among youth. Studies have indicated a relationship between hookah smoking and a high prevalence of chronic diseases, cancer, cardiovascular, and infectious diseases. In Israel, there has been a sharp increase in hookah smoking among the Arabs. Most studies have focused mainly on hookah smoking among young people., Objectives: To examine the association between hookah smoking and socioeconomic characteristics, health status and behaviors, and knowledge in the adult Arab population and to build a prediction model using machine learning methods., Methods: This quantitative study based is on data from the Health and Environment Survey conducted by the Galilee Society in 2015-2016. The data were collected through face-to-face interviews with 2046 adults aged 18 years and older., Results: Using machine learning, a prediction model was built based on eight features. Of the total study population, 13.0% smoked hookah. In the 18-34 age group, 19.5% smoked. Men, people with lower level of health knowledge, heavy consumers of energy drinks and alcohol, and unemployed people were more likely to smoke hookah. Younger and more educated people were more likely to smoke hookah., Conclusions: Hookah smoking is a widespread behavior among adult Arabs in Israel. The model generated by our study is intended to help health organizations reach people at risk for smoking hookah and to suggest different approaches to eliminate this phenomenon.

Objectives: Psychological distress is a problem strongly associated with socio-economic conditions. This study aims to assess rates of psychological distress and 'poor' self-rated health among Palestinian citizens of Israel, who constitute 21% of the population and nearly 50% live in poverty, and compare their psychological distress scores with those of the general Israeli population., Design: The Health and Environment Survey among Palestinian citizens of Israel (HESPI-2015), included a representative sample of this minority; 2018 individuals aged ≥18 were interviewed. The questionnaire included socio-demographic and health-related information, the General Health Questionnaire-12, (GHQ-12) and Self-rating of health (SRH)., Results: Subjects with GHQ-12 global scores of ≥17 were considered to have high distress. Low education, female gender, obesity and the presence of chronic diseases were significantly associated with high psychological distress over and above the effect of the other variables. Poor SRH was strongly associated with having a chronic disease and additional risk factors were older age group, low education and high psychological distress. Comparing psychological distress scores of Arabs in Israel with those of the general population showed that 30% of the former were classified as asymptomatic, as compared to 75% in the general population while the proportion of symptomatic or highly symptomatic was 14% in the latter as compared with 45% in the former., Conclusions: It appears that the burden of poverty, chronic disease and low education in this population, which suffers from multiple stressors, is disproportionate and should be addressed by the authorities, together with concrete plans to improve the education of the younger generations. Clearly, the association between discriminating policies and deprivation with psychological distress is not unique to the case of the Palestinian minority in Israel and therefore this study will allow for the examination and generalization of the current findings to other discriminated and disadvantaged minorities.

Background: Diabetes mellitus (DM) is considered one of the main causes of mortality, morbidity, and health care expenditures. Effectively treating this disease is of crucial importance and imposes a global challenge. The incidence of Type 2 DM (T2DM) is rapidly rising in both developing and developed countries. The Arab community in Israel is a distinct ethnic group with unique characteristics. Recently, this community has undergone major changes in its lifestyle, adopting the Westernized one, which could have caused an increase in the T2DM incidence rate., Objective: This review aims to shed light on various studies undertaken to explore the prevalence of diabetes and determine its current status in the Arab society of Israel, resting on previous and current data. It is presented to highlight the status of diabetes globally and to focus on its current situation in the Arab society of Israel, attempting to forecast its direction in the upcoming decade., Methods: Data were obtained from our previous comprehensive socio-economic and health crosssectional surveys for successive periods from 2004 to 2017. These surveys were conducted on the Arab society of Israel by the Galilee Society., Results: Our results showed a progressive increase in the prevalence of T2DM from 3.4% to 7.6% in the Arab society of Israel. This trend is expected to continue rising in the coming decade, and based on our predictions, may exceed 12% in 2030., Conclusion: Substantial and practical health-related actions must be initiated to prevent an increasing number of adults from developing diabetes and its complications., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: Type 2 Diabetes Mellitus (T2DM) is becoming increasingly prevalent and is considered to be a major public health threat worldwide. Behavioral and sociodemographic factors associated with T2DM vary within different societies., Objective: The aim of this study is to determine the various behavioral and sociodemographic factors associated with T2DM in the Arab society in Israel., Methods: A cross-sectional study was conducted based on data from 1,894 residents over the age of 21 belonging to the Arab population in Israel. The data collected from the subjects were subjected to statistical analyses using the SPSS program., Findings: Of the total sample population, 13.7% were found to be affected with T2DM. The prevalence of T2DM increased sharply in the successive age groups of both men and women. The prevalence of T2DM was found to increase progressively particularly in women with an increase in BMI (~20%, 37% and 44% respectively), while, in men it increased sharply (from 25% to ~50%) until a BMI of 29.9; it then decreased drastically (to ~24%) for a BMI of ≥30. About 85% of the men affected with T2DM were physically inactive, while 97% of the affected women were physically inactive. Almost half of the participants with diabetes have a family history of the disease in both genders. In the multivariate analysis, it was found that age, obesity, physical inactivity and family history of the disease were the significant factors associated with the prevalence of diabetes., Conclusions: It could be concluded that age, obesity, family history and physical inactivity were the significant factors associated with the prevalence of T2DM within the Arab society in Israel., Competing Interests: The authors have no competing interests to declare., (© 2019 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See http://creativecommons.org/licenses/by/4.0/.)

Background and Aim: Universal smoking cessation strategies are not always successful for minorities, among whom smoking is highly prevalent despite high intention to quit. This study identifies facilitators for smoking cessation, as perceived by minority male smokers, that can inform a culturally appropriate national plan for smoking prevention and cessation., Methods: We conducted in 2013 a three-stage study among Arab minority male current and former smokers (ages 18-64) in Israel, among whom smoking is very high: first, a Concept Mapping (CM) study with 102 and 202 participants in the brainstorming, and sorting and rating phases respectively. Second, we assigned clusters identified in the CM study to contingency levels using the Behavioral Ecological Model (BEM). Third, we classified clusters into intervention functions and policies using the Behavior Change Wheel (BCW)., Findings: The CM study revealed 58 barriers and facilitators for smoking prevention and cessation that were sorted into 11 clusters by the participants. These clusters were analogous to four BEM level contingency of smoking (social, institutional, community and individual). We classified it into two main policy categories, based on the BCW: 1- restructuring the socio-political environment of smoking through affirmative government's policies towards Arab minority in Israel, and 2-developing a culturally appropriate plan for smoking cessation in Arab local authorities including: raising awareness about tobacco hazards; enforcing anti-smoking laws; strengthening community institutional action; providing smoking cessation services; considering raising prices for tobacco products, addressing psychological sources of smoking in Arab men., Conclusions: Our study revealed barriers, facilitators and contingencies of smoking prevention and cessation with two main policy action items among the Arab minority in Israel: changing the socio-political environment of smoking, and developing a culturally appropriate smoking prevention and cessation national plan. Our study framework can inform policies and culturally appropriate interventions for smoking prevention and cessation in other minorities., Competing Interests: The authors have declared that no competing interests exist.