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R E V I E W
Drug and Alcohol Review (November 2015), 34, 660–662 DOI: 10.1111/dar.12269
BRIEF REPORT
Prevalence of illicit substance use among Arab adults in Israel: Findings from a national survey MAAYAN LAWENTAL1, MEYRAV SHOHAM2, PNINA RON1 & FAISAL AZAIZA1 1
School of Social Work, University of Haifa, Haifa, Israel, 2William Davidson Faculty of Industrial Engineering, Technion, Haifa, Israel
Abstract Introduction and Aims. The aim of this study was to examine illicit psychoactive substance use rates among adult Arabs in Israel. Design and Methods. Cross-sectional survey of 1200 Arab adults recruited nationwide via cluster sampling and interviewed using a structured questionnaire was conducted. Results. Fourteen percent of respondents reporting illegal substance use with increased odds of use among males and those who were secular/not religious. Discussion and Conclusions. These findings show for the first time the extent of illegal substance use among Arab adults in Israel and suggest the possibility for targeted interventions in certain population groups. [Lawental M, Shoham M, Ron P, Azaiza F. Prevalence of illicit substance use among Arab adults in Israel: Findings from a national survey. Drug Alcohol Rev 2015;34:660–2] Key words: illicit substance use, Arab adults, Israel.
Introduction The Arabs in Israel number over 1.4 million, corresponding to 20% of the population [1]. Arabs are distinct religiously and culturally from the Jewish majority and often live in separate localities, with lower average levels of education and standards of living [2]. Exposure to Jewish society, however, has led to changes in the norms, values and structure of Arab society [1,3]. By the 1990s, non-academic reports indicated that substance use was becoming more common among Arabs in Israel [4]. This can probably be at least partially attributed to the transition from a traditional to a modern society where behaviours such as alcohol use may be perceived as modern and thus more attractive to some [5]. Levels of education among Arabs in Israel have increased in recent decades [1], which may lead to the adoption of more
liberal views and discounting of religious values [5]. Ali [2], however, identified a trend of return to religion among Arabs in Israel (especially Muslims) that may oppose this. Previous studies have shown that gender is often linked to various forms of substance use, and its effect appears to be quite pronounced in Arab populations [6]. Unmarried people are at greater risk for substance use [7], while religious faith has been linked to substance use as a protective factor [8], especially with regard to alcohol consumption [6]. Few studies have examined illicit substance use among the adult Arab population in Israel, although several have examined Arab adolescents [9–12] and others the entire Israeli population [13].The aim of this report is to summarise illicit substance use rates among Arab adults in Israel and examine some broad demographic comparisons.
Maayan Lawental PhD, Assistant professor, Meyrav Shoham, PhD Candidate, Pnina Ron, PhD, Associate Professor, Faisal Azaiza, PhD, Full Professor. Correspondence to Dr Maayan Lawental, School of Social Work, University of Haifa, 188 Aba-Hushi Avenue, Mount Carmel, Haifa 3498838, Israel. Tel: 972 52 8706471; Fax: 972 77 9239223; E-mail: [email protected] Received 4 September 2014; accepted for publication 9 February 2015. © 2015 Australasian Professional Society on Alcohol and other Drugs
Substance use among Arab adults in Israel
Materials and methods One thousand two hundred Arab adults aged 18–40 were randomly sampled via cluster sampling and interviewed using a structured questionnaire. Seventeen localities were chosen based on size, location and residents’ religion, using nationwide cluster sampling. In 97 cases, no household member was available for interview (wrong ages, empty home), resulting in a 92.5% participation rate, with no refusals (n = 1200). Institutional review board approval from the ethics committee of the Faculty of Social Welfare & Health Sciences at the University of Haifa was sought and granted for this study. We used Arabic versions of measures utilised in previous epidemiological studies conducted by the Israel Anti-Drug Authority [9–13]. Respondents were asked about use of various illegal drugs [cannabis, methadone, opium, heroin, cocaine, crack, LSD, ecstasy and PCP, as well as about nonmedical use of medications (stimulants and tranquilizers)]. Substance use rates were examined at four points in time: lifetime use, past year, month and week (see Table 1). For each drug and each point in time, participants were asked to mark the extent to which they have used it on a 7-point Likert scale: not at all, once or twice, 3–5 times, 6–9 times, 10–19 times, 20–29 times and over 30 times. Answers were collapsed into any use versus no use. The large majority (83%) of respondents were Muslim, while the rest were Christian (17%); 56% were males, while a little over half were married (50.8%). The dataset was weighted to accommodate for the percentage of males and Muslims in the general Arab
661
population. For a detailed description of the sample including demographic characteristics, sampling method, instruments, study procedure and data analysis, please refer to the recent paper by Lawental et al. [14]. The relationship between gender, family status, religion and religiosity, and any illegal drug use was examined using bivariate logistic regressions (see Table 2 for actual odds ratios). Results Fourteen percent reported any lifetime illegal drug use; 8.1% reported use during the past year. The most common illicit drug among this population was cannabis, with 9.2% reported lifetime use and 5.2% reporting using the substance in the last year (Table 1). Odds of using illicit substances significantly increased with being male and secular or not religious. No significant differences were found between Muslims and Christians or married and non-married respondents (Table 2). Discussion This study is the first to provide a comprehensive picture of illicit substance use among adult Arabs in Israel. As in past studies of Arabs in Israel and elsewhere [6,9], men were more likely to use most substances. In Arab society, certain behaviours are considered unacceptable for women, including the use of psychoactive substances, even legal ones such as cigarettes [15]. The relatively low overall use rates we
Table 1. Drug use at four points in time (n = 1200, weighted percents) In the past
Any illegal use Medications Stimulants Tranquilizers Cannabis Hashish Marijuana Other illegal drugs Methadone Opium Heroin Cocaine Crack LSD Ecstasy PCP
Last year
Last month
Last week
n
%
n
%
n
%
n
%
176 68 18 60 119 93 89 54 15 8 11 13 8 11 31 6
14.0 5.7 1.4 5.0 9.2 7.2 6.9 4.3 1.2 0.7 0.9 1.1 0.7 0.9 2.5 0.5
101 37 11 33 67 56 33 27 9 6 5 7 7 9 14 6
8.1 3.1 0.9 2.8 5.2 4.4 2.6 2.2 0.8 0.5 0.4 0.6 0.6 0.7 1.1 0.5
55 21 10 17 38 30 24 19 6 6 5 7 5 7 9 6
4.4 1.7 0.8 1.4 3.0 2.4 1.9 1.6 0.5 0.5 0.4 0.6 0.4 0.6 0.7 0.5
37 14 6 12 26 20 14 14 6 4 4 5 5 6 6 5
2.9 1.1 0.5 1.0 2.0 1.6 1.1 1.1 0.5 0.4 0.3 0.4 0.4 0.5 0.5 0.4
© 2015 Australasian Professional Society on Alcohol and other Drugs
662
M. Lawental et al.
Table 2. Bivariate logistic regressions predicting lifetime illegal use
Gender: male (reference category: female) Family status: not currently married (reference category: married) Religion: Christian (reference category: Muslim) Religiosity: secular/not religious (reference category: religious/very religious)
OR
95% CI
Significance
0.162 0.929 0.683 0.373
0.087, 0.301 0.604, 1.428 0.373, 1.252 0.238, 0.585
0.000 0.737 0.217 0.000
CI, confidence interval; OR, odds ratio.
found likely reflect this. The use of measures employed in past studies in Israel allows us to begin identifying differences and patterns in future studies. Overall, past year illicit drug use was marginally lower in our ArabIsraeli sample (8%), compared with the wider Israeli population (11%) [10]. However, our study has several limitations. Data were collected using self-reports and therefore subject to inconsistencies in perception and possible misunderstandings and misrepresentation. Results may be somewhat reflective of willingness to report illicit substance use. Our methodology likely minimised this; past research indicates greater willingness to report cigarette use in face-to-face interviews among Arabs in Israel [15]. Results of this study have several implications. First, epidemiological initiatives should continue regularly, in order to track substance use and related developments over time. There is need for further research among minority groups, in Israel and elsewhere, utilising methodologies that will allow us to better understand the mechanisms leading to substance use and abuse.Third, the analyses yielded significant results that provide a better understanding of the phenomenon of substance use among Arabs, who are an ethnic minority in Israel, and shed light on the characteristics of those within this population who are likely to use psychoactive substances.Within this context, particular attention should be paid to issues surrounding religiosity, as they appear to play a crucial role in substance use. Finally, the results suggest that intervention and prevention efforts among Israeli Arab populations should be oriented to secular men who appear to use illegal psychoactive substances more frequently than other groups in the population.
References [1] Central Bureau of Statistics. The Arab population in Israel 2008. Jerusalem: Central Bureau of Statistics, 2009.
© 2015 Australasian Professional Society on Alcohol and other Drugs
[2] Ali N. The unpredictable status of Palestinian woman in Israel: actual versus desirable. 2006. Paper presented at Religion, Gender and Politics: An International Dialogue; The Van Leer Institute, Jerusalem. [3] Lavee Y, Katz R. Division of labor, perceived fairness, and marital equality: the effect of gender ideology. J Marriage Fam 2002;64:27–39. [4] Michaeli N. Drinking with no difference of religion and race. Everything About Alcohol 1995;6:4–5. [5] Weiss S, Sawa GH, Abdeen Z, Yanai J. Substance abuse studies and prevention efforts among Arabs in the 1990s in Israel, Jordan and the Palestinian Authority—a literature review. Addiction 1999;94:177–98. [6] Al-Omari H, Scheibmeir M. Arab Americans’ acculturation and tobacco smoking. J Transcult Nurs 2009;20:227–33. [7] Anderson P. Global use of alcohol, drugs and tobacco. Drug Alcohol Rev 2006;25:489–502. [8] Neumark YD, Rahav G, Jaffe DH. Socio-economic status and binge-drinking in Israel. Drug Alcohol Depend 2003;69:15–21. [9] Azaiza F, Shoham M, Bar-Hamburger R, Abu-Asba K. Patterns of psychoactive substance use among Arab secondary school students in Israel. Subst Use Misuse 2008; 43:1489–506. [10] Ezrahi Y, Roziner I, Nirel R, Bar-Hamburger R. Illegal use of drugs and alcohol in Israel 2009: seventh national epidemiological survey. Jerusalem: Israel Anti-Drug Authority, 2009. [11] Azaiza F, Shoham M, Bar-Hamburger R, Abu-Asba K. Substance use among Druze adolescent students in Israel: identifying predictors and patterns of use. J Stud Alcohol Drug 2008;69:840–7. [12] Azaiza F, Shoham M, Bar-Hamburger R, Abu-Asba K. Psychoactive substance use among Arab adolescent school dropouts in Israel: a phenomenon and its implications. Health Soc Care Comm 2009;17:27–35. [13] Rahav G, Teichman M, Gil R, Rosenblum Y, Bar-Hamburger R. The use of drugs and alcohol among the residents of Israel 2001: an epidemiological research V [Hashimush Besamim Ve’alcohol beKerev Toshvei Medinat Yisrael 2001: Mehkar Epidemiologi V]. Jerusalem: Israel Anti-Drug Authority, 2001. [14] Lawental M, Shoham M, Ron P, Azaiza F. Tobacco and alcohol use among Arab adults in Israel: findings from a nationwide study. Drug Alcohol Rev 2014;33:327–32. [15] Baron-Epel O, Haviv-Messika A, Green MS, Kalutzi ND. Ethnic differences in reported smoking behaviour in faceto-face and telephone interviews. Eur J Epidemiol 2004; 19:679–86.
R E V I E W
Drug and Alcohol Review (November 2015), 34, 660–662 DOI: 10.1111/dar.12269
BRIEF REPORT
Prevalence of illicit substance use among Arab adults in Israel: Findings from a national survey MAAYAN LAWENTAL1, MEYRAV SHOHAM2, PNINA RON1 & FAISAL AZAIZA1 1
School of Social Work, University of Haifa, Haifa, Israel, 2William Davidson Faculty of Industrial Engineering, Technion, Haifa, Israel
Abstract Introduction and Aims. The aim of this study was to examine illicit psychoactive substance use rates among adult Arabs in Israel. Design and Methods. Cross-sectional survey of 1200 Arab adults recruited nationwide via cluster sampling and interviewed using a structured questionnaire was conducted. Results. Fourteen percent of respondents reporting illegal substance use with increased odds of use among males and those who were secular/not religious. Discussion and Conclusions. These findings show for the first time the extent of illegal substance use among Arab adults in Israel and suggest the possibility for targeted interventions in certain population groups. [Lawental M, Shoham M, Ron P, Azaiza F. Prevalence of illicit substance use among Arab adults in Israel: Findings from a national survey. Drug Alcohol Rev 2015;34:660–2] Key words: illicit substance use, Arab adults, Israel.
Introduction The Arabs in Israel number over 1.4 million, corresponding to 20% of the population [1]. Arabs are distinct religiously and culturally from the Jewish majority and often live in separate localities, with lower average levels of education and standards of living [2]. Exposure to Jewish society, however, has led to changes in the norms, values and structure of Arab society [1,3]. By the 1990s, non-academic reports indicated that substance use was becoming more common among Arabs in Israel [4]. This can probably be at least partially attributed to the transition from a traditional to a modern society where behaviours such as alcohol use may be perceived as modern and thus more attractive to some [5]. Levels of education among Arabs in Israel have increased in recent decades [1], which may lead to the adoption of more
liberal views and discounting of religious values [5]. Ali [2], however, identified a trend of return to religion among Arabs in Israel (especially Muslims) that may oppose this. Previous studies have shown that gender is often linked to various forms of substance use, and its effect appears to be quite pronounced in Arab populations [6]. Unmarried people are at greater risk for substance use [7], while religious faith has been linked to substance use as a protective factor [8], especially with regard to alcohol consumption [6]. Few studies have examined illicit substance use among the adult Arab population in Israel, although several have examined Arab adolescents [9–12] and others the entire Israeli population [13].The aim of this report is to summarise illicit substance use rates among Arab adults in Israel and examine some broad demographic comparisons.
Maayan Lawental PhD, Assistant professor, Meyrav Shoham, PhD Candidate, Pnina Ron, PhD, Associate Professor, Faisal Azaiza, PhD, Full Professor. Correspondence to Dr Maayan Lawental, School of Social Work, University of Haifa, 188 Aba-Hushi Avenue, Mount Carmel, Haifa 3498838, Israel. Tel: 972 52 8706471; Fax: 972 77 9239223; E-mail: [email protected] Received 4 September 2014; accepted for publication 9 February 2015. © 2015 Australasian Professional Society on Alcohol and other Drugs
Substance use among Arab adults in Israel
Materials and methods One thousand two hundred Arab adults aged 18–40 were randomly sampled via cluster sampling and interviewed using a structured questionnaire. Seventeen localities were chosen based on size, location and residents’ religion, using nationwide cluster sampling. In 97 cases, no household member was available for interview (wrong ages, empty home), resulting in a 92.5% participation rate, with no refusals (n = 1200). Institutional review board approval from the ethics committee of the Faculty of Social Welfare & Health Sciences at the University of Haifa was sought and granted for this study. We used Arabic versions of measures utilised in previous epidemiological studies conducted by the Israel Anti-Drug Authority [9–13]. Respondents were asked about use of various illegal drugs [cannabis, methadone, opium, heroin, cocaine, crack, LSD, ecstasy and PCP, as well as about nonmedical use of medications (stimulants and tranquilizers)]. Substance use rates were examined at four points in time: lifetime use, past year, month and week (see Table 1). For each drug and each point in time, participants were asked to mark the extent to which they have used it on a 7-point Likert scale: not at all, once or twice, 3–5 times, 6–9 times, 10–19 times, 20–29 times and over 30 times. Answers were collapsed into any use versus no use. The large majority (83%) of respondents were Muslim, while the rest were Christian (17%); 56% were males, while a little over half were married (50.8%). The dataset was weighted to accommodate for the percentage of males and Muslims in the general Arab
661
population. For a detailed description of the sample including demographic characteristics, sampling method, instruments, study procedure and data analysis, please refer to the recent paper by Lawental et al. [14]. The relationship between gender, family status, religion and religiosity, and any illegal drug use was examined using bivariate logistic regressions (see Table 2 for actual odds ratios). Results Fourteen percent reported any lifetime illegal drug use; 8.1% reported use during the past year. The most common illicit drug among this population was cannabis, with 9.2% reported lifetime use and 5.2% reporting using the substance in the last year (Table 1). Odds of using illicit substances significantly increased with being male and secular or not religious. No significant differences were found between Muslims and Christians or married and non-married respondents (Table 2). Discussion This study is the first to provide a comprehensive picture of illicit substance use among adult Arabs in Israel. As in past studies of Arabs in Israel and elsewhere [6,9], men were more likely to use most substances. In Arab society, certain behaviours are considered unacceptable for women, including the use of psychoactive substances, even legal ones such as cigarettes [15]. The relatively low overall use rates we
Table 1. Drug use at four points in time (n = 1200, weighted percents) In the past
Any illegal use Medications Stimulants Tranquilizers Cannabis Hashish Marijuana Other illegal drugs Methadone Opium Heroin Cocaine Crack LSD Ecstasy PCP
Last year
Last month
Last week
n
%
n
%
n
%
n
%
176 68 18 60 119 93 89 54 15 8 11 13 8 11 31 6
14.0 5.7 1.4 5.0 9.2 7.2 6.9 4.3 1.2 0.7 0.9 1.1 0.7 0.9 2.5 0.5
101 37 11 33 67 56 33 27 9 6 5 7 7 9 14 6
8.1 3.1 0.9 2.8 5.2 4.4 2.6 2.2 0.8 0.5 0.4 0.6 0.6 0.7 1.1 0.5
55 21 10 17 38 30 24 19 6 6 5 7 5 7 9 6
4.4 1.7 0.8 1.4 3.0 2.4 1.9 1.6 0.5 0.5 0.4 0.6 0.4 0.6 0.7 0.5
37 14 6 12 26 20 14 14 6 4 4 5 5 6 6 5
2.9 1.1 0.5 1.0 2.0 1.6 1.1 1.1 0.5 0.4 0.3 0.4 0.4 0.5 0.5 0.4
© 2015 Australasian Professional Society on Alcohol and other Drugs
662
M. Lawental et al.
Table 2. Bivariate logistic regressions predicting lifetime illegal use
Gender: male (reference category: female) Family status: not currently married (reference category: married) Religion: Christian (reference category: Muslim) Religiosity: secular/not religious (reference category: religious/very religious)
OR
95% CI
Significance
0.162 0.929 0.683 0.373
0.087, 0.301 0.604, 1.428 0.373, 1.252 0.238, 0.585
0.000 0.737 0.217 0.000
CI, confidence interval; OR, odds ratio.
found likely reflect this. The use of measures employed in past studies in Israel allows us to begin identifying differences and patterns in future studies. Overall, past year illicit drug use was marginally lower in our ArabIsraeli sample (8%), compared with the wider Israeli population (11%) [10]. However, our study has several limitations. Data were collected using self-reports and therefore subject to inconsistencies in perception and possible misunderstandings and misrepresentation. Results may be somewhat reflective of willingness to report illicit substance use. Our methodology likely minimised this; past research indicates greater willingness to report cigarette use in face-to-face interviews among Arabs in Israel [15]. Results of this study have several implications. First, epidemiological initiatives should continue regularly, in order to track substance use and related developments over time. There is need for further research among minority groups, in Israel and elsewhere, utilising methodologies that will allow us to better understand the mechanisms leading to substance use and abuse.Third, the analyses yielded significant results that provide a better understanding of the phenomenon of substance use among Arabs, who are an ethnic minority in Israel, and shed light on the characteristics of those within this population who are likely to use psychoactive substances.Within this context, particular attention should be paid to issues surrounding religiosity, as they appear to play a crucial role in substance use. Finally, the results suggest that intervention and prevention efforts among Israeli Arab populations should be oriented to secular men who appear to use illegal psychoactive substances more frequently than other groups in the population.
References [1] Central Bureau of Statistics. The Arab population in Israel 2008. Jerusalem: Central Bureau of Statistics, 2009.
© 2015 Australasian Professional Society on Alcohol and other Drugs
[2] Ali N. The unpredictable status of Palestinian woman in Israel: actual versus desirable. 2006. Paper presented at Religion, Gender and Politics: An International Dialogue; The Van Leer Institute, Jerusalem. [3] Lavee Y, Katz R. Division of labor, perceived fairness, and marital equality: the effect of gender ideology. J Marriage Fam 2002;64:27–39. [4] Michaeli N. Drinking with no difference of religion and race. Everything About Alcohol 1995;6:4–5. [5] Weiss S, Sawa GH, Abdeen Z, Yanai J. Substance abuse studies and prevention efforts among Arabs in the 1990s in Israel, Jordan and the Palestinian Authority—a literature review. Addiction 1999;94:177–98. [6] Al-Omari H, Scheibmeir M. Arab Americans’ acculturation and tobacco smoking. J Transcult Nurs 2009;20:227–33. [7] Anderson P. Global use of alcohol, drugs and tobacco. Drug Alcohol Rev 2006;25:489–502. [8] Neumark YD, Rahav G, Jaffe DH. Socio-economic status and binge-drinking in Israel. Drug Alcohol Depend 2003;69:15–21. [9] Azaiza F, Shoham M, Bar-Hamburger R, Abu-Asba K. Patterns of psychoactive substance use among Arab secondary school students in Israel. Subst Use Misuse 2008; 43:1489–506. [10] Ezrahi Y, Roziner I, Nirel R, Bar-Hamburger R. Illegal use of drugs and alcohol in Israel 2009: seventh national epidemiological survey. Jerusalem: Israel Anti-Drug Authority, 2009. [11] Azaiza F, Shoham M, Bar-Hamburger R, Abu-Asba K. Substance use among Druze adolescent students in Israel: identifying predictors and patterns of use. J Stud Alcohol Drug 2008;69:840–7. [12] Azaiza F, Shoham M, Bar-Hamburger R, Abu-Asba K. Psychoactive substance use among Arab adolescent school dropouts in Israel: a phenomenon and its implications. Health Soc Care Comm 2009;17:27–35. [13] Rahav G, Teichman M, Gil R, Rosenblum Y, Bar-Hamburger R. The use of drugs and alcohol among the residents of Israel 2001: an epidemiological research V [Hashimush Besamim Ve’alcohol beKerev Toshvei Medinat Yisrael 2001: Mehkar Epidemiologi V]. Jerusalem: Israel Anti-Drug Authority, 2001. [14] Lawental M, Shoham M, Ron P, Azaiza F. Tobacco and alcohol use among Arab adults in Israel: findings from a nationwide study. Drug Alcohol Rev 2014;33:327–32. [15] Baron-Epel O, Haviv-Messika A, Green MS, Kalutzi ND. Ethnic differences in reported smoking behaviour in faceto-face and telephone interviews. Eur J Epidemiol 2004; 19:679–86.
