Name Health Risk Behaviours of Palestinian Youth: findings from a representative survey

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


Peter Glick,1 Umaiyeh Al-Khammash,2,3 Mohammed Shaheen,4 Ryan Brown,1Prodyumna Goutam,1 Rita Karam,1 Sebastian Linnemayr 1 and Salwa Massad3,5

1RAND Corporation, Santa. Monica, California, United States of America (Correspondence to: Peter Glick: .). 2Juzoor for Health and Social Development, Ramallah, West Bank. 3United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), East Jerusalem, Palestine. 4Al Quds University, Abu-Dis, West Bank. 5Palestinian National Institute of Public Health, West Bank.


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.

Keywords: youth, health risk behaviours, Palestine, survey

Citation: Glick P; Khammash U; Shaheen M; Brown R; Goutam P; Karam R; et al. Health risk behaviours of Palestinian youth: findings from a representative survey. East Mediterr Health J. 2018;24(2):127-136. 

Received: 27/06/16; accepted: 15/05/17

Copyright © World Health Organization (WHO) 2018. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (


Relatively little is known about key health risk behaviours among youth in the Middle East and North Africa (MENA), leaving public health authorities in the region unprepared to deal with emerging public health threats at a time of major social changes. Rates of tobacco use among younger adolescents aged 13–15 years, for whom systematic data are available, are higher in the MENA region than in other regions other than Latin America and the Caribbean (1). Although youth-specific data are lacking, the use of injecting drugs has been noted in many countries, including Lebanon, Libya, Morocco, Oman, Saudi Arabia and Tunisia (2), and there is evidence of significant recent increases in the use of amphetamines, opioids and other drugs, particularly in the countries bordering the Persian Gulf (3). With regard to sexual activity among youth, a rising age of marriage throughout the region as well as increases in rates of sexually transmitted infections (2,4) suggest increasing rates of sexual activity outside of (and before) marriage. In Morocco, 40% of reported sexually transmitted infections are among 15–29-year-olds (5).

Youth in the occupied Palestinian territory of the West Bank, East Jerusalem and Gaza are experiencing similar risks, including particularly high rates of tobacco use (6,7). Drug use, especially in East Jerusalem, is a growing concern (8). Youth unemployment, considered a risk factor for drug use (9,10), is very high (26% and 55% in the West Bank and Gaza, respectively, for those aged 20–24 years) (11). A further potential risk factor facing Palestinian youth is the stress of sustained political conflict and economic hardship. An understanding of the patterns and causes of youth health risk behaviours will enable policymakers to develop and target appropriate prevention programmes (12).

Existing studies of youth in the occupied Palestinian territory and the region have serious drawbacks that limit our understanding of the prevalence and patterns of most risk behaviours. These studies mostly use school-based samples of adolescents rather than representative, random samples of youth that include out of school and older youth, who may be at greatest risk. Existing surveys also typically do not cover many key risk behaviours (in particular sensitive behaviours such as sexual activity), or do so only in terms of perceptions regarding peers, not the youth’s own engagement.

The Palestinian Youth Health Risk Study addresses this gap and to our knowledge is the first in the region to collect large scale, representative data on risk behaviours among youth including smoking, alcohol and drug use, sexual activity and interpersonal violence. The study was designed to investigate levels and patterns of these behaviours as well as mental health among Palestinian youth, youths’ perceptions of the risks and benefits of such behaviours and their expectations about the future, and the relationship of exposure to violence and conflict to mental health, future orientation and engagement in risk behaviours. This paper presents findings on the prevalence of risk behaviours among youth aged 15–24 years, considering variations by sex, age and location. Location is a potentially important determinant given the differences between rural and urban areas of the occupied Palestinian territory—and between them and refugee camps—with respect to cultural attitudes, access to alcohol and drugs, and economic and political tensions.


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