Introduction: The rapid expansion of digital learning, accelerated by the COVID-19 pandemic, has highlighted the importance of social support systems in shaping students’ engagement. This study examines how parental involvement, parental support, and teacher support are associated with students’ engagement in digital learning, with a particular focus on the mediating role of self-efficacy.Materials and methods: A national cross-sectional survey was conducted among 1019 students aged 10–18 (69% girls). Participants completed an online questionnaire assessing social support, self-efficacy, and engagement in digital learning. Hierarchical regression analyses and path analysis were used to examine direct and indirect associations among the variables.Results: All three support sources were positively associated with students’ engagement in digital learning. The path analysis further indicated that self-efficacy mediated the relationships between parental involvement, parental support, and teacher support and engagement in digital learning. The direct effects of parental support and teacher support remained statistically significant after accounting for the mediator, whereas the direct effect of parental involvement was reduced to marginal significance, indicating partial mediation.Conclusions: The findings suggest that social support contributes to students’ engagement in digital learning largely through enhancing self-efficacy. These results underscore the importance of strengthening both school- and home-based support systems, alongside interventions aimed at fostering students’ confidence in their learning abilities.

Injuries are a leading public health priority within adolescent populations; however, few cross-national studies have examined their epidemiology over time. We described time trends in adolescent self-reported medically treated injury across 31 mainly European countries over 20 years, then explored whether observed temporal trends varied according to the prevalence of known behavioral risk factors. The data source included six cycles of the Health Behavior in School-aged Children study (2002-22; weighted n = 954 298, participants aged 11-15 years). Outcomes included self-reports of any and multiple medically treated injuries. Measures of behavioral risks included indicators of violence, substance use, and physical activity. Within countries reporting increases in injuries, variations in reported engagement in known behavioral risk factors were examined. Nearly half of adolescents reported at least one medically treated injury (47%-53% of boys; 38%-44% of girls) and nearly one quarter reported multiple injuries (23%-30% of boys; 16%-22% of girls). In the pooled analysis, temporal trends included increases in any medically treated injury for girls (all age groups) and boys (11 years only) and multiple injuries (boys and girls, all age groups). At the country-level, we observed more temporal increases than decreases. Increases in physical activity were observed coincident with observed injury trends. In one of the largest European analyses of its kind, we demonstrated the ongoing burden of adolescent injury. Persistently high rates of adolescent injuries are concerning, and the origins of temporal increases require an initial focus on sport and physical activity.

An increasing body of literature shows the impact of the COVID-19 pandemic and associated lockdown measures on the mental health and well-being of adolescents. However, few studies have examined how national-level lockdown measures, specifically school closures, are related to levels of peer violence among adolescents. The Health Behaviour in School-aged Children (HBSC) study allows a unique opportunity to examine cross-nationally across representative samples of adolescents, the relationship between days of school closure and levels of school and cyberbullying perpetration and victimization and physical fighting. The current cross-sectional study, which includes data from 244,405 children (50.6

(1) Background: Toothbrushing behavior in children and adolescents is shaped by national dental health policies and sociodemographic and psychological factors. In 2010, child dental care was incorporated into Israel’s National Health Insurance Law (NHIL). This study explored toothbrushing behavior and its predictors before and after this reform. (2) Methods: Data from 36,755 students in grades 6–10 were analyzed from the Health Behaviour in School-Aged Children study conducted pre-reform (1998, 2002, 2006) and post-reform (2010, 2013, 2016). The dependent variable was toothbrushing behavior, while the independent variables included sociodemographic and psychological characteristics. Chi-squared tests compared proportions of compliant toothbrushing behaviors, and logistic regression identified significant predictors. (3) Results: According to recommendations, 59–64% of children brushed their teeth before the reform. This proportion increased significantly post-reform, reaching 73% in 2018. Predictors of compliance included being female, younger, Jewish, and non-observant, having a higher socioeconomic status, and having a better psychological status. These predictors were consistent in pre- and post-reform regression models. (4) Conclusions: The dental care reform positively influenced toothbrushing habits among children and adolescents. However, disparities remain among specific communities. Interventions tailored to address sociodemographic and psychological factors are recommended to enhance regular toothbrushing habits across all populations.

School bullying and cyberbullying are serious public health problems that negatively affect the lives of school-aged children. We examined the correlation between risk behaviors and lack of resiliency factors with bullying and cyberbullying across seven Mediterranean countries. The sample consisted of 33,399 adolescents (51.1% girls) aged 11, 13, and 15 years who participated in the Health Behavior in School-aged Children (HBSC) survey in 2018 in Greece, Israel, Italy, Macedonia, Malta, Portugal, and Spain. Bivariate logistic regressions were conducted to test the relationship between risk behaviors, resilience, and bullying. All risk behaviors and lack of resiliency factors examined were related to involvement in bullying as a victim, perpetrator, or bully-victim, both in school and cyberbullying. Moreover, the odds of involvement in school bullying and cyberbullying increased as the number of risk behaviors and the lack of resiliency factors grew. Our results may contribute to the development and implementation of anti-bullying programs.

Volunteering can serve as a protective factor against substance abuse. Yet, it is unclear whether volunteering in specific community organizations, such as emergency services, promotes or protects against substance use. We aimed to (1) describe community volunteering characteristics among adolescents; (2) investigate differences in the prevalence of substance use according to community volunteering type; and (3) determine whether volunteering type was a predictor of substance use. We analyzed data from the 2018-2019 Health Behavior in School-aged Children survey among Israeli adolescents aged 11-17 years (N = 3972). Most participants (N = 2452; 61.7%) did not volunteer at all, 27.1% (N = 1077) volunteered in youth movements/councils, and 11.2% (N = 443) volunteered in community emergency services. In comparison to the emergency services group, there was a higher volunteering frequency among the youth movements/councils group. Of the three groups (nonvolunteering, volunteering in youth movements/councils, and volunteering in community emergency services), those in the community emergency services group reported a significantly higher prevalence of weekly alcohol use, lifetime cannabis use, and new psychoactive drug use, while no significant between-group differences were observed in smoking tobacco prevalence. Volunteering in the community emergency services has been linked to substance use, requiring the development of intervention programs by the school staff, before their active volunteering (e.g., guidance on emotional stress and substance abuse). Also, teachers can act as a protective factor for students, and identify emotional distress and anxiety in their students to prevent substance abuse. Furthermore, emergency services workers and instructors should also be aware of the higher risk of substance use among volunteering youth and should be given tools to better collaborate with parents and teachers in dealing with it.

Harm reduction services, such as drug testing kiosks and 'safe zones' are often advocated for reducing the harms of drug use among rave and festival attendees. However, interaction with law enforcement can undermine efforts at introducing formal harm reduction services. This cross-sectional, client-oriented study aims to frame the potential components of a tolerance-based policy in outdoor raves in Israel, which assumes a continued police presence, and availability of harm reduction services. The study described the views of outdoor rave attendees towards the role of police, willingness to use harm reduction services, and help-seeking behaviours. Overall, participants reported negative attitudes towards current policing at outdoor raves and a low intention-to-seek help from the police when in physical or emotional distress. Only 13% of responders viewed police presence at raves as important for keeping event areas safe. Furthermore, 85% claimed police presence would prevent them from using drug testing services if these become available. Report of lifetime drug use at raves was significantly and inversely associated with willingness to seek help from the police in cases of physical or emotional distress (Odds Ratio = 0.15, Confidence Interval: 0.08, 0.30). This negative perception of police presence at large outdoor raves indicates low support and trust for current policing approaches, and that these approaches may be a barrier to the introduction of formal harm reduction services under the current prohibitionist approach. These results underpin the need to reform current law enforcement practices towards tolerance-based approaches that permit access to harm reduction services.

Abstract Background Cardiovascular diseases (CVD) are a precursor for disabilities and death worldwide. Being overweight or obese in combination with physical inactivity and smoking habits may increase the risk for CVD and other health problems such as lower limb osteoarthritis, diabetes, stroke, and various cancer types among children and adolescents. The literature emphasizes the need to follow such groups and evaluate the risk of individuals developing CVD diseases. Therefore, the current study explores the variety of cardiovascular risks in children and adolescents’ profiles clusters with and without disabilities. Methods Data from 42 countries including Israel, was collected with the support of the world health organization (WHO, Europe) through a questionnaire from 11–19 years old school-aged. Results The study finding shows that children and adolescents with disabilities demonstrated a higher prevalence of overweight than those who completed the HBSC youth behavior survey. Moreover, the prevalence of tobacco smoking and alcohol use was statisticaly significantly higher among the disabled group than the non-disabled group. In addition, socioeconomic status of responders who presented a very high CVD risk was found as significantly lower than those from the first and second low risk groups. Conclusion This led to the conclusion that children and adolescents with disability were at a higher risk of developing CVDs than their non-disabled peers. In addition, intervention programs tailored to the needs of adolescents with disability should consider lifestyle habit change and promoting healthy living thus improving their quality of life as well as reducing their risk of being exposed to severe CVD diseases.

Adolescence is a critical period of growth in which youth are vulnerable to a variety of risk factors that affect their development, including exposure to psychoactive substances. Studies showed that health risk behaviors tend to be interrelated with evidence suggesting a cumulative impact of these behaviors. The current study aims to examine the accumulation of risk factors and the accumulated lack of resiliency factors that predict substance use among youth in the northern Mediterranean region. Data were obtained from the Health Behavior in School-Aged Children study in 2018/2019. Adolescents (10,084; age 15; 51.7% girls) were selected using representative cluster sampling and surveyed by questionnaire in the classroom. Findings revealed that cumulative risk factors and a cumulative lack of resiliency factors were associated with a higher likelihood of psychoactive substance use. Furthermore, each additional unit of increase in either risk factors or lack of resiliency factors demonstrated higher odds of substance use. Among the examined resiliency factors, negative school feelings and lack of familial support emerged as the most significant predictors of substance use. Likewise, early sexual initiation was the most prominent predictor among the examined risk factors. Our findings demonstrated the importance of resiliency factors in reducing adolescents’ risk behaviors. It may also contribute to developing and implementing intervention programs specifically designed for the shared characteristics and culture of the Mediterranean countries to prevent substance use among adolescents.

Few studies have analyzed harm reduction behaviors and attitudes among rave party attendees. Since the late 1980s, there has been a large Israeli rave scene, also known as 'Nature Parties'. However, only a few studies have been conducted among nature party attendees and almost all of them are from a qualitative perspective. This study's aim was to fill the gap and conduct quantitative research to investigate the patterns of substance use, harm reduction attitudes and behaviors among Israeli nature rave party attendees. A cross-sectional online survey recruited 1,206 people who reported having attended nature rave parties. All of the participants were aged 18–60 years (M = 29.9; SD = 7.4), and 770 (64

Despite the low utilization rates of substance use and related disorders services, and the ability of internet-based interventions for substance use and related disorders (IBIS) to address challenges related to service engagement, limited attention has been placed on the processes for the accommodation of these interventions to diverse cultural settings. This study aimed to develop a framework for the cultural accommodation of IBIS across populations based on a pilot study and a literature review. A pilot study of cultural accommodation of an existing internet intervention for alcohol use was carried out in Israel, which involved focus groups and daily online surveys of prospective consumers (N = 24) as well as interviews with experts (N = 7) in the substance abuse treatment field. Thematic analysis revealed a range of themes that relate to the general Israeli culture and the specific Israeli drinking subculture, identified as needing to be addressed in the process of intervention accommodation. A comprehensive framework for cultural accommodation of IBIS is suggested, consisting of five stages: Technical and cultural feasibility; Engagement of target group; Identification of accommodation variables, Accommodation, and evaluation of the accommodated intervention. In addition, the framework consists of four dimensions of accommodation: Barriers and facilitators; Audio-visual materials and language; Mechanisms of change; Intersectional factors. We suggest that the proposed framework may serve as a guide for the cultural accommodation of existing internet-based interventions for substance use and related disorders across a range of cultural and geographical settings, thus augmenting the ecological validity of internet-based interventions for substance use and related disorders, expanding cross-cultural intervention research, and reducing health disparities worldwide.

Cardiovascular diseases (CVDs) are the number one cause of death globally and are partially due to the inability to control modifiable lifestyle risk factors. The aim of this study was to analyze the profiles of adolescents from seven Mediterranean countries (Greece, Israel, Italy, Macedonia, Malta, Portugal, Spain) according to their modifiable lifestyle risk factors for CVD (overweight/obesity, physical activity, smoking, alcohol consumption). The sample consisted of 26,110 adolescents (52.3% girls) aged 11, 13, and 15 years who participated in the Health Behavior in School-aged Children (HBSC) survey in 2018 across the seven countries. Sociodemographic characteristics (sex, age, country of residence, socioeconomic status) and CVD modifiable lifestyle risk factors (overweight/obesity, physical activity, smoking, alcohol consumption) were recorded. A two-step cluster analysis, one-way analysis of variance, and chi-square test were performed. Four different cluster groups were identified: two low-risk groups (64.46%), with risk among those with low physical activity levels; moderate-risk group (14.83%), with two risk factors (unhealthy weight and low physical activity level); and a high-risk group (20.7%), which presented risk in all modifiable lifestyle risk factors. Older adolescents reported a higher likelihood of being in the high-risk group. Given that the adolescence period constitutes an important time for interventions aimed at CVD prevention, identifying profiles of moderate- and high-risk adolescents is crucial.

This study investigated the relationship between biopsychosocial characteristics (age, sex, self-rated health, mental health, parental socio-economic status, family support, teacher support, peer support) and alcohol consumption (weekly alcohol consumption in the past three months, drunkenness in the past three months, and binge drinking in the past month) in adolescents during a crisis event. The study consisted of 1019 Israeli students aged 11–18. Questionnaires were distributed to the students between May and July 2021 during school. Teacher support among those who presented weekly alcohol consumption and drunkenness in the past three months was lower than in those who did not present such behavior. The effects of parental support differed only for drunkenness behavior, with those who engaged in drunken behavior presenting significantly less parental support. Our findings suggest that teacher support and mental health are the two major factors in preventing risky alcohol consumption behavior during a crisis, such as the COVID-19 pandemic, among adolescents.

Active travel (AT) is a core physical activity (PA) indicator for children and youth; contributing to health and wellbeing, at both the individual and societal levels. This analysis explores patterns of adolescent active school travel (AST) and cycling and associations with different PA measures. Secondary analysis of the cross-sectional 2018–2019 Health Behaviour in School Age Children study in Israel included an extended PA module with walking, cycling and e-cycling modes. The nationally representative sample includes students in grades 6–12 (n = 4407). Analysis of weighted data included descriptive analyses, inferential statistics, and regression analyses. AST was reported by 61.9% of adolescents; 39.3% reported 20 min or more daily AST; 27.1% reported habitual cycling (HC) and 17.4% reported habitual e-cycling (HEC). There are mixed results for socio-economic status and environment. AST and HC were associated with less sedentary hours daily (odds ratio [OR] = 1.190 and 1.397, respectively); HC was associated with positive sports self-rating (OR = 2.394). Stepwise regression analysis found that lower AST duration, time in minutes, was associated with watching television with the family. Promotion of adolescent AT may be associated with increased PA and joint parent-adolescent AT, and was utilized across different socio-demographic groups in Israel.

In recent years, several studies have examined the effect of parents and friends on cyberbullying victims. Less is known about their combined effect on cyber perpetrators, especially among Jewish and Arab teens in Israel. We collected data from a representative sample of 350 Jewish and Arab adolescents (aged 15-16) and their parents. We repeated the interviews twice within a year. The survey included measurements of three parental practices: support, monitoring, and protectiveness, as reported by parents at the first time of data collection. We measured the adolescents' engagement in sensation-seeking and cyberbullying as perpetrators and perceptions about peers' involvement in these behaviors. Path-analysis models revealed that the perception of peers' involvement in cyberbullying perpetration was positively linked with involvement in such behavior among Jewish and Arab teens. Contrary to our expectations, no parental practice had a direct effect on cyberbullying perpetration among teens in either ethnic group. The study presents important and unique findings. The results indicate that youngsters involved in cyberbullying are strongly influenced by their peers. The prevalence of this pattern in both the Jewish and the Arab populations indicates its universal nature. On a practical level, it may be suggested that bullying behaviors may be mitigated by taking measures in formal and informal education. Another aspect of the results is the decline in parental influence on adolescents' cyberbullying behaviors, especially among Arab teens. This may be an indicator of cultural changes taking place in the Arab population in Israel alongside widening of the generation gap.

We investigated the prevalence of risk behaviors among Israeli adolescents (tobacco smoking, alcohol consumption, drug use) during the COVID-19 pandemic. Associations between different risk behaviors were examined and so was whether specific characteristics could predict risk behaviors in adolescents. The study consisted of 1020 Israeli adolescents aged 15–18. Study subjects completed an online survey between the first and second lockdowns in Israel (April 2020 to September 2020). Participants reported the frequency at which they engaged in four different risky behaviors: general risky behavior, tobacco smoking, alcohol consumption (binge drinking), and cannabis use. The most prevalent risky behavior in the sample was binge drinking (33.8%). The four measured risky behaviors were significantly correlated. Among participants who had previously engaged in a risky behavior assessed, most did not change the behavior frequency during the pandemic. All independent variables (sociodemographic characteristics, family support, and emotional, health excluding friends’ support, physical activity volume, and coronavirus restrictions) were significantly different between participants engaging vs. not engaging in risky behaviors. Our findings suggest that family support is one of the most influential factors in preventing risky behavior during the pandemic, and they emphasize the importance of family-based interventions with children and adolescents from elementary to high school.

Adolescent alcohol use is a subject of concern. Despite research showing an association between parenting behaviors and alcohol use, scarce research has examined whether associations are similar across immigrant status. This question is relevant given that immigration can disrupt parent–adolescent relations. The aim of the current study was to examine the moderating role of parenting behaviors (support, parental knowledge, and communication) on the association between immigrant status and alcohol use (drunkenness and heavy episodic drinking). The study included representative samples of first- and second-generation immigrant adolescents from the Former Soviet Union (FSU; N = 1,167) and Ethiopia ( N = 385), and non-immigrant ( N = 6,669) adolescents in Israel. Non-immigrant adolescents reported higher levels of parenting behaviors and lower levels of alcohol use than immigrant adolescents. Parenting behaviors were negatively associated with alcohol use, but there were no interactions between parenting behaviors and immigrant status. However, differences in parenting behaviors partly explained differences in alcohol use across groups.

Schools with health-promoting school (HPS) frameworks are actively committed to enhancing healthy lifestyles. This study explored the contribution of school participation in HPS on students’ health behaviors, namely, physical activity (PA), sedentary behavior, and dieting. Data from the 2018/2019 Health Behavior in School-aged Children study on Israeli adolescents aged 11–17 years were used. Schools were selected from a sample of HPSs and non-HPSs. Between-group differences and predictions of health behavior were analyzed. No between-group differences were observed in mean number of days/week with at least 60 min of PA (HPS: 3.84 ± 2.19 days/week, 95% confidence interval of the mean = 3.02–3.34; non-HPS: 3.93 ± 2.17 days/week, 95% confidence interval of the mean = 3.13–3.38). Most children engaged in screen time behavior for >2 h/day (HPS: 60.83%; non-HPS: 63.91%). The odds of being on a diet were higher among more active children (odds ratio [OR] = 1.20), higher socio-economic status (OR = 1.23), and female (OR = 2.29). HPS did not predict any health behavior. These findings suggest that HPSs did not contribute to health behaviors more than non-HPSs. Therefore, health-promoting activities in HPSs need to be improved in order to justify their recognition as members of the HPS network and to fulfill their mission.

The study's purpose was to examine the prevalence of sedentary screen time behaviour and physical activity (PA) participation, and their association with environmental (socioeconomic status, bullying behaviours) and personal factors (age, sex). We analysed data from the 2013–14 Health Behaviour in School-aged Children survey among Israeli adolescents aged 11–17 [N = 4,241; 56% female; 9.3% = adolescents with disability (AWD)]. A minority (<10%) of all participants complied with the 2010 World Health Organization global PA recommendations. AWD were significantly more involved in bullying behaviours. PA participation was significantly decreased in AWD in grades 6 and 8 compared to adolescents without disability. Furthermore, > 30% of AWD and adolescents without disability engaged in sedentary screen time >3 hours/day. In conclusion, AWD in grades 6 and 8 should be given specific attention, to reduce the likelihood of bullying at school and to increase the inclusion of AWD in PA lessons.