Mohammed Shaheen

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

BackgroundYouth 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.MethodsThe 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.ResultsMost 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.ConclusionsAlthough 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.

Perceptions of sexual risk behavior among Palestinian youth in the West Bank: a qualitative investigation.

BackgroundYoung people in the Middle East and North Africa (MENA) are profoundly affected by violence, high unemployment, and economic hardship. Experiences of community-level violence and personal trauma increase the likelihood that young people will engage in risky behaviors that include smoking, drug use, and unsafe sex. Little is known about the sexual behavior of young people in the region, particularly in the occupied Palestinian territory (oPt). Our aim in this study was to gain an insight into the perceived prevalence and patterns of sexual behavior among Palestinian youth.MethodsThe study was based on ten focus groups and 17 in-depth interviews with young people aged 16-24 years as part of the formative phase of a cross-sectional representative study of risk behaviors in the West Bank, including Jerusalem, in 2012. The sample was selected using a combination of purposive and convenience sampling. Qualitative analysis was used to code detailed notes of focus groups and interviews.ResultsBased on participants’ reports, different types of sexual activity outside marriage were not uncommon, even in conservative communities. The most reported sexual activity was non-penetrative sex: oral and anal intercourse, and virtual sex. Some young people had sexual intercourse with sex workers; they went to brothels in Israel and to brothels operating clandestinely in the West Bank, including East Jerusalem. Most respondents were of the opinion that young people did not usually use protection during sexual intercourse. Many reported that youth engage in different types of sexual activity outside marriage for several reasons: to challenge the culture, financial constraints and inability to marry, basic human need, personal pleasure, suppression, to kill boredom, and to prove manhood.ConclusionsIn contrast with the conservative social context of the occupied Palestinian territory (oPt), the findings suggest that sexual activities outside marriage may be more common than is currently assumed. Sexual behavior in the oPt is a concern because of the low awareness of the potential health consequences. The results draw attention to the need to incorporate sexual reproductive health into the national agenda and ensure that it is included in the programs of national institutions.

Health risk behaviours of Palestinian youth: findings from a representative survey

Background There is little systematic information about health risk behaviours among youth in Middle Eastern countries, leaving public health authorities unprepared to deal with emerging public health threats at a time of major social change. Aim The Palestinian Youth Health Risk study investigates patterns of risk behaviours among Palestinian youth, their perceptions of the risks and benefits of such behaviours, and the relationship of exposure to violence with mental health and engagement in risk behaviours. Methods We conducted a representative survey among 2500 individuals aged 15-24 years in the West Bank and East Jerusalem, permitting reliable comparison across sex and rural-urban divisions. A stratified 2-stage random sample was drawn from the 2007 population census, with strata formed by crossing the 12 governorates with urban, rural and refugee camp locations. Within strata, 208 survey clusters were sampled with probability proportional to size. Within each cluster, 14 households with youth of the appropriate age were sampled. Results Among youth aged 20-24 years, 22.4% of males and 11.6% of females reported trying alcohol; 10.5% of males and 4.3% of females reported trying drugs. Almost one quarter of unmarried youth aged 20-24 years reported any sexual experience. Tobacco use is high, even among younger youth (45.4% of males and 21.2% of females aged 15-19 smoke). Risk behaviours are higher among males, older youth and in urban areas and refugee camps. Conclusion While smoking is of particular concern, prevention outreach for all behaviours should be directed at subgroups and areas identified as highest risk.

Perceptions of drug use and sexual behaviours of adolescents in the West Bank, occupied Palestinian territory: a qualitative study

Background Little is known about the health-risk behaviours of young people in the Middle East, particularly the occupied Palestinian territory (oPt). Our aim in this study was to gain insights into the prevalence and patterns of risk-taking behaviours of Palestinian youth. Methods We organised ten focus groups and 17 in-depth interviews with young people (aged 16–24 years) as part of the formative phase of a cross-sectional representative study of risk behaviours in the West Bank, including East Jerusalem, oPt, in 2012. A combination of purposive and convenience sampling was used to select the sample, with representation of male and female young people from different localities in the region (urban, rural, refugee camps). The non-probability sample was balanced across these categories, but the people whom we interviewed might not be representative of the overall young Palestinian population. NVivo (version 9) was used for the qualitative analysis. RAND Corporation, Santa Monica, CA, USA, approved the study protocol in January, 2012. We obtained informed verbal consent from participants aged 18 years and older, and assent from participants younger than 18 years and their parents. Findings 83 individuals (42 male and 41 female; mean age 20·0 years [SD 2·2]) participated in the study. Participants reported that substance use and sexual activity outside marriage were common, even in conservative communities. Use of drugs, the most common of which were hashish and marijuana, was perceived to be especially prevalent in refugee camps and in East Jerusalem. The most commonly reported types of sexual activity were oral and anal intercourse. Vaginal intercourse was less common than were other types of sexual intercourse outside marriage. Some young people had sexual intercourse with sex workers; they went to brothels in the West Bank, including East Jerusalem, and in Israel. Most respondents were of the opinion that young people did not usually use protection during sexual intercourse. Interpretation To the best of our knowledge, this is the first study of the health-risk behaviours of young Palestinian people. By contrast with the conservative social context in the oPt, the findings suggest that drug use and unprotected sexual intercourse outside marriage might be more common than is currently assumed. These results might be perceived as indicating surprisingly high rates of sexual and other risky behaviours; however, we cannot exclude the possibility that participants might have overstated or understated drug use and sexual behaviours, but this possibility is unlikely to be a major concern for focus groups discussing young people in general and for participants who are of the opinion that there is a high prevalence of these behaviours. Health-risk behaviours in the oPt are a concern because of the low awareness of the potential health consequences. The results draw attention to the need to include sexual reproductive health on the national agenda and ensure that it is included in the programmes of national institutions. The formative findings from this study will be used to further explore the issues in a larger representative sample to improve understanding of prevalence, patterns, and causes of risk-taking behaviours. Funding National Institutes of Health, Bethesda, MD, USA.

Perceived Peer Norms, Health Risk Behaviors, and Clustering of Risk Behaviors Among Palestinian Youth

Relatively little is known about patterns of health risk behaviors among Middle Eastern youth, including how these behaviors are related to perceived peer norms. In a sample of approximately 2,500 15–24 year old Palestinian youth, perceived engagement of general peers in alcohol consumption, drug use and sexual activity was substantially greater than youths’ own (self-reported) engagement in these activities, suggesting a tendency to overestimate the prevalence of risk-taking behavior among peers. Individual participation in a risk behavior strongly covaries with the perceived levels of both friends’ and peers’ engagement in that behavior (p = 0.00 in each case). In addition, significant clustering of risk behaviors is found: youth who participate in one risk behavior are more likely to participate in others. These findings for a rare representative sample of Middle Eastern youth are strikingly similar to those in the US and Europe. The clustering of behaviors suggests that prevention programs should be structured to deal with a range of connected risk behaviors for which certain youth may be at risk. The findings also suggest that adjusting expectations about peers’ behavior may reduce young Palestinians’ engagement in risk taking.