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      Substance use among Palestinian youth in the West Bank, Palestine: a qualitative investigation

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          Youth health risk behaviors, including substance use (psychoactive substances including alcohol and illicit drugs), have been the subject of relatively limited study to date in Middle Eastern countries. This study provides insights into the perceived prevalence and patterns of alcohol and drug use among Palestinian youth.


          The study was based on ten focus groups and 17 individual interviews with youth aged 16–24 years ( n = 83), collected as part of the formative phase of a cross-sectional, population representative study of risk taking behaviors among Palestinian youth in the West Bank in 2012. Qualitative analysis was used to code detailed notes of focus groups and interviews.


          Most participants reported that substance use exists, even in socially conservative communities. Almost all participants agreed that alcohol consumption is common and that alcohol is easily available. The top alcoholic drinks referred to by the study participants were vodka, whisky, beer, and wine. Most participants claimed that they drink alcohol to cope with stress, for fun, out of curiosity, to challenge society, and due to the influence of the media. Participants were familiar with illicit drugs and knew of youth who engaged in drug use: marijuana, cocaine, and heroin were mentioned most frequently. Study participants believed that youth use drugs as a result of stress, the Israeli occupation, inadequate parental control, lack of awareness, unhappiness, curiosity, and for entertainment. Many participants were unaware of any local institutions to support youth with substance use problems. Others expressed their distrust of any such institution as they assumed them to be inefficient, profit-driven, and posing the risk of potential breaches of confidentiality.


          Although this study uses a purposive sample, the results suggest that substance use exists among Palestinian youth. Risk behaviors are a concern given inadequate youth-friendly counseling services and the strong cultural constraints on open discussion or education about the impact of high risk behaviors. These barriers to treatment and counseling can exacerbate the health and social consequences of alcohol abuse and illicit drug use.

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          Most cited references 15

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          The effects of political violence on Palestinian children's behavior problems: a risk accumulation model.

          Interviews with 150 Palestinian mothers and their children living amidst the Intifada in the West Bank were conducted to assess exposure to political violence and family negativity as risk factors associated with behavioral problems as measured by the Child Behavior Checklist. The number of risks present in the child's life was significantly correlated with the number of behavioral problems the child exhibited (R = .53, p < .001). The analysis further examined the role of gender, age, and community context in moderating the impact of high levels of accumulated risk on children's behavioral problems. Under conditions of high accumulated risk, boys evidenced more problems than girls, and younger children exhibited more problems than older children. Community context (as indicated by a high or low level of political violence) was a significant factor for girls but not for boys.
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            Adolescent substance use and sexual risk-taking behavior.

            To examine the relationship of adolescent substance use and dependence to sexual risk-taking behavior in late adolescence and young adulthood. We prospectively examined self-reported sexual behaviors and substance involvement questionnaires in a sample of youth in substance abuse treatment programs and a comparison sample of sociodemographically similar community youths without histories of substance use disorders recruited from media ads. Assessments of sexual behaviors and substance involvement (78% white, 51% female) were collected at 2, 4, and 6 years after initial assessments, as they transitioned from middle adolescence to young adulthood (from age 15.5 to age 21.5 years, on average). The two samples were compared using Chi-square, analysis of variance, and multivariate analysis of variance approaches. Continuous indicators of high-risk sexual behaviors and substance involvement were analyzed with multiple regression. Earlier age of onset to sexual activity, more sexual partners, less consistent use of condoms, more sexually transmitted diseases (STDs), and greater prevalence of human immunodeficiency virus testing were reported by youth in the clinical treatment sample relative to sociodemographically comparable nonabusing community youth. High rates of STDs were found among females, and more substance-abusing females reported pregnancies than community females. Substance involvement continued to be associated with high-risk sexual behavior throughout the transition into young adulthood. Youth identified with substance problems are more likely to engage in risky sexual behaviors during adolescence and to continue risky sexual behaviors to the extent that substance problems persist. Risk reduction education should be included with adolescent substance abuse treatment.
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              Clustering of smoking, alcohol drinking and cannabis use in adolescents in a rapidly developing country

              Background Smoking, alcohol drinking and cannabis use ("risk behaviors") are often initiated at a young age but few epidemiological studies have assessed their joined prevalence in children in developing countries. This study aims at examining the joint prevalence of these behaviors in adolescents in the Seychelles, a rapidly developing country in the Indian Ocean. Methods Cross-sectional survey in a representative sample of secondary school students using an anonymous self-administered questionnaire (Global Youth Tobacco Survey). The questionnaire was completed by 1,321 (92%) of 1,442 eligible students aged 11 to 17 years. Main variables of interest included smoking cigarettes on ≥1 day in the past 30 days; drinking any alcohol beverage on ≥1 day in the past 30 days and using cannabis at least once in the past 12 months. Results In boys and girls, respectively, prevalence (95% CI) was 30% (26–34)/21% (18–25) for smoking, 49% (45–54)/48% (43–52) for drinking, and 17% (15–20)/8% (6–10) for cannabis use. The prevalence of all these behaviors increased with age. Smokers were two times more likely than non-smokers to drink and nine times more likely to use cannabis. Drinkers were three times more likely than non-drinkers to smoke or to use cannabis. Comparison of observed versus expected frequencies of combination categories demonstrated clustering of these risk behaviors in students (P < 0.001). Conclusion Smoking, drinking and cannabis use were common and clustered among adolescents of a rapidly developing country. These findings stress the need for early and integrated prevention programs.

                Author and article information

                +970-2-2414488 ,
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                17 August 2016
                17 August 2016
                : 16
                [1 ]Palestinian National Institute of Public Health, Ramallah, West Bank Palestine
                [2 ]Al Quds University, Abu Dis, Palestine
                [3 ]Rand Corporation, Santa Monica, USA
                [4 ]United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), Jerusalem, Palestine
                [5 ]Juzoor for Health and Social Development, Al-Arkan St, Al-Bireh, West Bank Palestine
                © The Author(s). 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

                Funded by: FundRef, National Institutes of Health;
                Research Article
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                © The Author(s) 2016

                Public health

                youth, alcohol, drugs, palestine


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