Change in health behaviours following acute coronary syndrome: Arab-Jewish differences.
BACKGROUND
Health-promoting behaviours after acute coronary syndrome (ACS) are effective in preventing recurrence. Ethnicity impacts on such behaviours. We assessed the independent association of Arab vs. Jewish ethnicity with persistence of smoking and physical inactivity 6 months after ACS in central Israel.


METHODS
Prospective cohort study.


METHODS
During their admission for ACS and subsequently 6 months later, 420 patients were interviewed about their smoking and exercise habits. The association of ethnicity with health-promoting behaviours was assessed by logistic regression adjusting for socio-demographic and clinical covariates.


RESULTS
Smoking prevalence and physical inactivity were substantially higher among Arab patients than Jewish patients at admission (gender-adjusted prevalence rate ratio (RR) 2.25, 95% CI 1.80-2.81, p < 0.01 and RR 1.46, 95% CI 1.28-1.67, p < 0.001, respectively). The relative differences increased at 6 months (RR 2.94, 95% CI 2.13-4.07, p < 0.001 and RR 3.00, 95% CI 2.24-4.04, p < 0.001, respectively). Excess persistent smoking at 6 months among Arab vs. Jewish patients who were smokers at admission (adjusted OR 2.05, 95% CI 1.00-4.20, p = 0.049) was largely mediated through the 3.5-fold higher participation of Jewish patients in cardiac prevention and rehabilitation program (CPRP) (OR adjusted also for CPRP 1.31, 95% CI 0.59-2.93, p = 0.51). Greater persistent sedentary behaviour at 6 months among nonexercisers at admission among Arab patients (adjusted OR 3.68, 95% CI 1.93-7.02, p < 0.001) was partly mediated through attendance of CPRP (OR adjusted also for CPRP 2.38, 95% CI 1.19-4.76, p = 0.014).


CONCLUSIONS
Culturally sensitive programmes need to be developed to enhance CPRP participation and favourable health-promoting changes among Arab patients. A comprehensive understanding of the determinants of the Arab-Jewish differences in efficacious health-promoting behaviours is crucial to inform appropriate ethnic-specific health-promoting strategies.
Hebrew University and Hadassah Medical Center, Jerusalem, Israel Clalit Research Institute, Tel-Aviv, Israel Meir Medical Center, Kfar-Saba, Israel orna.reges@gmail.com ornare@clalit.org.il.
Orna
O
Reges
Bar-Ilan University, Ramat-Gan, Israel.
Noa
N
Vilchinsky
Clalit Research Institute, Tel-Aviv, Israel New York University, New York, USA.
Morton
M
Leibowitz
Meir Medical Center, Kfar-Saba, Israel.
Abdulrahem
A
Khaskia
Meir Medical Center, Kfar-Saba, Israel.
Morris
M
Mosseri
Hebrew University and Hadassah Medical Center, Jerusalem, Israel.
Jeremy D
JD
Kark
D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000208:ethnology* / Q000523:psychology* / Q000534:rehabilitation; D000368:Aged; D018912:Arabs / Q000523:psychology*; D016009:Chi-Square Distribution; D003466:Cultural Characteristics; D015444:Exercise / Q000523:psychology; D005260:Female; D006184:Habits; D015438:Health Behavior / Q000208:ethnology*; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D006293:Health Promotion; D006801:Humans; D007557:Israel / Q000453:epidemiology; D007585:Jews / Q000523:psychology*; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D040242:Risk Reduction Behavior; D057185:Sedentary Behavior / Q000208:ethnology; D012907:Smoking / Q000009:adverse effects / Q000208:ethnology / Q000523:psychology; D016540:Smoking Cessation / Q000208:ethnology / Q000523:psychology; D000074606:Smoking Prevention; D013997:Time Factors
Acute coronary syndrome; Arabs; Jews; cardiac prevention; ethnicity; exercise; gender; health-promoting behaviours; rehabilitation program; smoking