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Drug and alcohol use among the Bedouin of the Negev: Prevalence and psychosocial correlates
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Addictive Behaviors 33 (2008) 143 – 151
Short communication
Drug and alcohol use among the Bedouin of the Negev: Prevalence and psychosocial correlates Gary M. Diamond a,⁎, Aneese Farhat a , Mahmud Al-Amor b , Salman Elbedour c , Karni Shelef a , Rachel Bar-Hamburger b a
Department of Behavioral Sciences, Ben-Gurion University of the Negev, POB 653, Beer-Sheva, 84105, Israel b Israel Anti-Drug Authority, Cnafe Nesherim 7, POB 3985, Jerusalem, 91039, Israel c School of Education, Howard University. 2441 4th Street, NW, Washington, DC 20059, United States
Abstract The primary aim of this study was to estimate the prevalence of drug and alcohol use among the Bedouin of the Negev. A representative sample of 821 adults and 440 adolescents were surveyed using the Arabic version of the Israeli National Epidemiological Questionnaire. Almost 14% of adult Bedouins used alcohol and 11.1% used illicit drugs during the past year, with rates higher among individuals living in government settlements than those living in unrecognized traditional villages. Among adolescents, 21.9% used alcohol and 20.4% used drugs over the past year, with rates higher for high school students than for school attritters. Drug use was positively associated with being male, having a tolerant attitude toward drug use, the perception that drugs were not dangerous, being secular, low family cohesion and either low or high family adaptability. These data suggest that drug use is prevalent among the Bedouin of the Negev, particularly among adolescents, who report using drugs such as narcotics, cocaine, and hallucinogens at rates 3 to 8 times greater than Israeli Jewish secular students. School-based and family-based prevention and treatment programs may be most effective for this population. © 2007 Elsevier Ltd. All rights reserved. Keywords: Drugs; Alcohol; Bedouin; Survey; Israel
⁎ Corresponding author. Current address: Department of Psychology, Ben-Gurion University of the Negev, Be'er Sheva, Israel. Tel.: +972 8 647 2083; fax: +972 8 647 2932. E-mail addresses: [email protected] (G.M. Diamond), [email protected] (A. Farhat), [email protected] (M. Al-Amor), [email protected] (S. Elbedour), [email protected] (K. Shelef), [email protected] (R. Bar-Hamburger). 0306-4603/$ - see front matter © 2007 Elsevier Ltd. All rights reserved. doi:10.1016/j.addbeh.2007.04.028
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1. Introduction The Bedouin of the Negev are Muslim Arabs who have inhabited the Negev desert since the fifth century CE and, today, number approximately 150,000. Traditionally organized into nomadic or semi-nomadic tribes, over the past half-century they have experienced rapid and dramatic transition, with half of the population being resettled into seven urban-style, government settlements. The forced move from traditional semi-nomadic life to underdeveloped urban settlements has had farreaching social and economic consequences, including decreased family cohesion, more densely populated living conditions, and high rates of unemployment and poverty (Abu-Saad, 2003; Lithwick, 2003), placing them at greater risk for drug use (Guo, Hill, Hawkins, Catalano, & Abbott, 2002). Results from the only previous study of drug use among Bedouin adults found that, indeed, drug use was higher than in the Israeli population at large, with those adults living in government settlements reporting marijuana and other drug use at rates two to three times greater than adults living in traditional, unrecognized villages (Abu-Saad, 1998). These findings, however, should be interpreted with caution since the sample did not include women. Recent findings from a subset of 250 Bedouin adolescents who participated in the latest National Epidemiological Study indicate that 12.7% of Bedouin high school students had used illicit drugs over the past year as compared to 10.3% of Jewish high school students. Furthermore, 10.8% of Bedouin students reported using other drugs, including narcotics, cocaine and hallucinogens — a rate almost four times higher than the rate for such drug use among their Jewish counterparts (Bar-Hamburger et al., 2005). Unexpectedly, Bedouin school attriters reported using illicit drugs at a substantially lower rate (7.7%) than did Bedouin high school students (12.7%). This finding is important in the light of the extremely high rate of school attrition (up to 70% by 12th grade) among Bedouin adolescents. More research utilizing larger, more representative samples and standardized instruments is needed. 2. Method 2.1. Sample and sampling procedure A total of 821 adults, age 19 or older, and 440 adolescents, between the ages of 14 and 18 years, were included in this survey. Both stratification and clustering sampling procedures were employed. The final sample of residents from government settlements was 66% male, with an average age of 26 (SD = 8.17) years. The final sample of participants from unrecognized villages was 65% male, with an average age of 26 (SD = 7.36) years. The adolescent sample was stratified according to educational status and included 295 high school students and 145 school attriters. Two high schools (out of nine) were randomly chosen, and then 3 classrooms from each grade (9th through 12th) at each school were randomly sampled. Fifty-two percent of the school students surveyed were boys, with an average age of 16 (SD = 1.36) years. School attriters were randomly sampled from various gathering places (e.g., marketplace, arcades), government sponsored after-school program for school attriters and via door-to-door surveying procedures. Seventy-nine percent of the school attriters surveyed were boys, with an average age of 17 (SD = 1.23) years.
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2.2. Assessors The questionnaires were administered by a group of 6 Bedouin college students, ranging in age from 18 to 25 years. Two of the assessors were women and 4 were men. 2.3. Data collection procedure Surveys were administered individually (except in school classrooms) and anonymously. All data were collected between the years of 2002 and 2003. 2.4. Measurements This study employed an abbreviated, Arabic version of the National Epidemiological Questionnaire (NEQ). The questionnaire includes demographic questions, questions regarding drug use, and two measures assessing respondents' attitudes (i.e., tolerance and perceived dangerousness) toward drug use. Both attitude measures have proven reliable and predicted drug use in previous studies (BarHamburger et al., 2005). In this study, the tolerance towards drugs measure evidenced an Alpha Chronbach of 0.80 for adolescents and 0.88 for adults, and the dangerousness measure evidenced an Alpha Chronbach of 0.91 for adolescents and 0.92 for adults. The NEQ also includes the short version of the Family Adaptability and Cohesiveness Environment Scale (Faces-III; Olson, Portner, & Lavee, 1985). The FACES-III measures two dimensions of family functioning — cohesion and adaptability. The psychometric properties of both subscales are good (Olson et al., 1985). In this study, the internal
Table 1 Past year prevalence rates (%) for each type of drug — adults Type of drug
Settlements
Villages
All adults
Any alcohol Wine Beer Liquor Any drugs Prescription medication Sleeping pills/sedatives Speed Cannabis Hashish Marijuana Other drugs Methadone Heroin/Opium Cocaine Crack L.S.D. Ecstasy PCP/Poppers
17.0 14.1 11.7 11.8 13.5 7.7 6.5 4.8 11.0 8.3 9.9 7.5 4.4 4.4 4.4 4.2 4.2 4.2 3.3
11.0 8.0 8.7 4.4 8.8 5.6 4.6 3.2 5.0 3.8 4.6 3.1 1.1 0.7 1.4 0.9 1.2 1.2 1.0
13.9 11.0 10.2 8.1 11.1 6.6 5.5 4.0 7.5 6.0 7.2 5.3 2.7 2.6 2.9 2.6 2.7 2.7 2.2
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G.M. Diamond et al. / Addictive Behaviors 33 (2008) 143–151
Table 2 Past year prevalence rates (%) according to drug and demographics — adults Any alcohol
Any drug
Cannabis
Prescription drugs
Other drugs
N
Gender Male Female χ2
9.0 4.1 14.34⁎⁎⁎
7.7 2.7 17.67⁎⁎⁎
5.8 1.3 19.69⁎⁎⁎
4.3 2.2 5.13⁎
3.3 1.6 4.28⁎
471 253
Age 18–24 25–34 35 + χ2
13.6 14.7 12.7 n.s.
10.4 12.7 10.3 n.s.
6.6 8.2 8.9 n.s.
5.9 7.5 7.3 n.s.
5.4 4.1 7.7 n.s.
411 293 114
Religiosity Devout Practicing Secular χ2
4.4 10.9 57.2 201.7⁎⁎⁎
5.6 10.5 30.4 55.0⁎⁎⁎
3.7 5.4 23.4 51.29⁎⁎⁎
4.6 6.0 16.0 17.73⁎⁎⁎
3.1 4.9 11.9 14.97⁎⁎⁎
357 332 114
⁎p b 0.05, ⁎⁎p b 0.01, ⁎⁎⁎p b 0.001.
Table 3 Past year prevalence rates (%) according to cognitive and family variables — adults Any alcohol
Any drug
Cannabis
Prescription drugs
Other drugs
N
1.0 7.9 33.4 133.48⁎⁎⁎
1.8 7.6 24.1 75.65⁎⁎⁎
0.8 3.7 17.6 67.80⁎⁎⁎
1.0 4.9 14.1 41.89⁎⁎⁎
0.4 2.7 12.5 46.48⁎⁎⁎
289 255 273
Dangerousness Low Moderate High χ2
29.3 11.8 1.2 93.82⁎⁎⁎
23.4 8.4 0.7 76.86⁎⁎⁎
18.2 3.0 0.0 79.26⁎⁎⁎
14.2 6.1 0.3 42.20⁎⁎⁎
11.0 4.1 0.3 32.85⁎⁎⁎
279 257 278
Cohesiveness Low Middle High χ2
18.3 16.3 6.7 16.40⁎⁎⁎
14.6 11.6 7.4 7.16⁎
11.0 6.9 4.5 8.10⁎
8.8 7.3 4.2 n.s.
11.0 6.9 4.5 8.10⁎
272 281 258
Adaptability Low Middle High χ2
18.1 9.8 13.5 8.36⁎
13.9 9.0 10.4 n.s.
10.6 5.4 6.7 6.31⁎
8.5 5.5 5.6 n.s.
6.2 4.0 5.3 n.s.
293 286 228
Tolerance Low Moderate High χ2
⁎p b 0.05, ⁎⁎p b 0.01, ⁎⁎⁎p b 0.001.
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consistency estimate for the cohesion subscale was α = 0.75 and for the adaptability scale α = 0.65 for the adolescent sample, and 0.87 for the cohesion scale and 0.71 for the adaptability scale for the adult sample. 2.5. Statistical analyses Prevalence rates were calculated in frequencies. The association between drug use and demographic/ psychosocial variables was calculated using Chi-Square analyses. 3. Results 3.1. Past year prevalence rates of drug and alcohol use, and their psychosocial correlates, among adult Bedouins Over the past year, 13.9% of adult Bedouins reported using alcohol and 11.1% reported using at least one type of illicit substance (see Table 1). Adults living in government settlements reported higher rates of alcohol use, illicit drug use, cannabis use, and other drug use than those living in traditional, unrecognized villages. Across the entire adult sample, males used alcohol and drugs at a higher rate than did females (see Table 2). While there was no relation between age and alcohol or drug use, there was an association with religiosity, with those adults identifying themselves as secular reporting the highest rates of alcohol and drug use (see Table 2). The more tolerant adults' attitude toward alcohol and drug use, and the less dangerous they perceived drugs and alcohol to be, the higher their rate of reported alcohol and drug use (see Table 4 Past year prevalence rates (%) for each type of drug — adolescents Type of drug
Students (N = 295)
School attriters (145)
All adolescents (N = 440)
Any alcohol Wine Beer Liquor Any drugs Prescription medication Sleeping pills/sedatives Speed Cannabis Hashish Marijuana Other drugs Methadone Heroin/Opium Cocaine Crack L.S.D. Ecstasy PCP/Poppers
23.3 17.4 18.3 19.0 27.7 19.6 15.5 16.4 18.0 16.4 16.4 25.4 17.8 16.9 15.8 15.9 16.4 15.9 14.0
20.5 13.7 15.7 13.7 13.1 10.7 9.4 5.8 12.7 10.7 9.2 9.9 7.0 5.6 5.6 3.7 7.0 5.5 3.3
21.9 15.5 17.0 16.3 20.4 15.2 12.5 11.1 15.4 13.5 12.8 17.6 12.4 11.3 10.7 9.8 11.7 10.7 8.7
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Table 5 Past year prevalence rates (%) according to demographics — adolescents Any alcohol
Any drug
Cannabis
Prescription drugs
Other drugs
N
Gender Male Female χ2
31.5 12.3 20.58⁎⁎⁎
26.8 12.6 12.47⁎⁎⁎
22.0 8.1 14.34⁎⁎⁎⁎
19.5 9.2 8.01⁎⁎⁎
21.7 11.9 7.07⁎⁎⁎
267 170
Age −14 15–16 17+ χ2
23.7 28.6 15.9 9.72⁎⁎
22.0 26.8 13.8 10.61⁎⁎
19.0 21.9 8.5 15.84⁎⁎⁎
22.0 21.1 8.1 15.94⁎⁎⁎
22.0 23.0 10.8 12.05⁎⁎
29 165 258
Religiosity Devout Practicing Secular χ2
16.8 23.1 39.4 11.22⁎⁎
19.0 14.5 47.7 26.20⁎⁎⁎
13.0 10.3 45.3 37.86⁎⁎⁎
13.8 11.2 39.0 22.96⁎⁎⁎
18.0 11.4 41.6 24.91⁎⁎⁎
192 205 46
⁎p b 0.05, ⁎⁎p b 0.01, ⁎⁎⁎p b 0.001.
Table 2). Family environment was also associated with alcohol and drug use: the more cohesive the family environment, the lower the rate of adults' alcohol and drug use. The relation between family adaptability and alcohol and marijuana use was curvilinear, with adults from moderately adaptable (flexible) homes reporting lower rates of alcohol and marijuana use than adults living in low and highly adaptive families. Family adaptability was not associated with the use of other drugs (see Table 3). 3.2. Past year prevalence rates of drug and alcohol use, and their psychosocial correlates, among adolescents Almost 22% of Bedouin adolescents reported using alcohol and 20.4% reported using at least one type of illicit substance over the past year (see Table 4). While school attenders and attriters reported using alcohol at practically equal rates, school attenders reported using illicit drugs, including narcotics and hallucinogens, at over twice the rate of school attriters. Across the entire sample of adolescents, males used alcohol and drugs at higher rates than did females (see Table 5). Across all types of drugs and alcohol, usage rates were higher among 14–16 year olds than they were among 17–18 year olds. Furthermore, adolescents who identified themselves as coming from a devout or traditional Muslim home used illicit drugs and alcohol at lower rates than those adolescents who reported coming from secular homes (see Table 5). The more tolerant the adolescent's attitude toward alcohol and drug use, and the less dangerous the adolescent perceived alcohol and drugs to be, the higher their rate of alcohol and drug use (see Table 6). Also, the more cohesive the family environment, the lower the rate of adolescents' alcohol use (see Table 6). The relationship between family adaptability and drug use, however, was curvilinear, with those adolescents coming from moderately adaptable (flexible) homes reporting the
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Table 6 Past year prevalence rates (%) according to cognitive and family variables — adolescents Any alcohol
Any drug
Cannabis
Prescription drugs
Other drugs
N
Tolerance Low Moderate High χ2
6.1 28.0 34.6 41.05⁎⁎⁎
7.0 21.1 35.9 39.20⁎⁎⁎
2.5 16.9 29.8 44.39⁎⁎⁎
3.4 17.0 28.3 36.55⁎⁎⁎
4.7 17.9 32.6 41.13⁎⁎⁎
166 134 147
Dangerousness Low Moderate High χ2
28.5 23.6 10.8 13.76⁎⁎⁎
26.0 21.6 10.3 11.84⁎⁎
20.1 17.7 5.4 14.60⁎⁎⁎
18.2 17.7 6.5 9.75⁎⁎
21.5 18.5 9.6 7.91⁎
154 154 136
Cohesiveness Low Middle High χ2
27.4 24.3 13.2 9.66⁎⁎
26.1 20.2 13.8 7.34⁎
22.4 15.1 8.3 11.75⁎⁎
23.4 14.4 8.3 13.06⁎⁎
24.1 16.9 11.0 8.66⁎⁎
142 148 156
Adaptability Low Middle High χ2
18.0 23.6 26.7 n.s.
20.6 13.9 26.9 7.39⁎
15.4 8.5 21.8 9.39⁎⁎
15.9 11.1 18.8 n.s.
16.9 12.4 23.9 6.34⁎
166 140 138
⁎p b 0.05, ⁎⁎p b 0.01, ⁎⁎⁎p b 0.001.
lowest rate of drug use. There was no relation between family adaptability and alcohol use (see Table 6). 4. Discussion Overall, adult Bedouins reported using illicit drugs at a rate (11%) similar to that found among the general Israeli adult population, though they reported using certain drugs – such as narcotics, cocaine and hallucinogens – at a rate more than twice that found among their Israeli counterparts (Bar-Hamburger et al., 2005). As expected, adult Bedouins reported a substantially lower rate of alcohol use than their Israeli peers, most likely due to Islam's explicit prohibition of alcohol use (Al-Krenawi, Graham, & Sehwail, 2002). Also as expected, Bedouins living in government settlements used drugs and alcohol substantially more than those living in unrecognized, traditional villages. This finding is consistent with findings from the Abu-Saad (1998) study and may be attributable to the stress, family and social disintegration, and unemployment associated with the move from an agrarian, traditional, ritualized lifestyle to the more isolated, less structured, and more anonymous lifestyle found in the larger and more densely populated government settlements. Approximately 22% of Bedouin adolescents reported using alcohol and approximately 20% reported using at least one type of illicit substance over the past year. The prevalence rate for illicit drugs was over
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twice the rate found among the general, primarily Jewish, Israeli public high school population (BarHamburger et al., 2005). In fact, Bedouin high school students reported using drugs such as narcotics, cocaine and hallucinogens at rates 3 to 8 times greater than Jewish secular students. This finding is both worrisome and consistent with findings from the most recent National Epidemiological Survey (BarHamburger et al., 2005). Interestingly, and also consistent with findings from the most recent National Epidemiological study, the rate of drug use among Bedouin school attriters appears to be lower than among school attenders. In fact, Bedouin high school students used drugs such as narcotics, cocaine and hallucinogens at two and a half times the rate of attriters. These findings are divergent from results from studies examining the general Israeli population (Bar-Hamburger et al., 2005) and North American samples (Johnston, O'Malley, Bachman, & Schulenberg, 2006), which indicate that adolescents not in school are particularly at risk. Whereas school attrition among the general Israeli population and other Western cultures typically reflects failure in the socialization process and is associated with poor academic functioning, psychological symptoms, and low parental monitoring, among the Bedouin, having adolescents remain at home to help with agricultural and family responsibilities is culturally normative. In this context, the majority of Bedouin adolescents who are not in school may actually be engaged in productive activities and may be subjected to heightened parental involvement and monitoring. Drug use among both adult and adolescent Bedouin was associated with a number with a number of psychosocial factors. In general, lower drug use was associated with being female, greater religiosity, less tolerant attitudes toward drugs, the perception of drugs being dangerous, greater family cohesion and moderate levels of family adaptability. These findings must be interpreted in the context of a number of methodological limitations. Most importantly, the measure did not include a valid index of response veracity. Consequently, we were unable to estimate what percentage of respondents may have over-reported their drug use. Nor was there any method to detect potential underreporting. In a closed society such as the Bedouin, stigma could potentially lead members to deny the use of drugs — even when assured that their reports are unidentifiable. Despite these limitations, the findings from this study are based on the most representative and reliable data collected to date on drug use among the Bedouin of the Negev. They indicate the dire need for extensive prevention and treatment programs, particularly school-based and family-based programs. Acknowledgement This study was supported by a grant from the Israel Anti-Drug Authority. We would like to acknowledge the contributions of Lilly Noiman and Giora Rahav to this project. A full report of these findings can be obtained by contacting the first author. References Abu-Saad, I. (1998). The influence of settlement on substance use and abuse among nomadic populations in Israel and Kenya (Project code number 92-2.1). Scientific report: Israel development research program. Abu-Saad, I. (2003). Bedouin Arabs in Israel between the Hammer and the Anvil: Education as a Foundation for Survival and Development. In I. Abu-Saad & D. Champagne (Eds.), The future of indigenous peoples: Strategies for survival and development (pp. 103−120). UCLA, Los Angeles: American Indian Studies Center.
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Al-Krenawi, A., Graham, J. R., & Sehwail, M. A. (2002). Alcohol and drug abuse from an Islamic Perspective: Implications for intervention. In R. Israloqitz, M. Afifi, & R. Rawson (Eds.), Drug problems: Cross-cultural policy and program development. Connecticut, USA: Auburn House. Bar-Hamburger, R., Ezrahi, Y., Steinberg, D., Roziner, A., Ovadia, N., & Moshe, T. (2005). Drug and alcohol use among residents of Israel 2001: Epidemiological study VI. Jerusalem: Israel Anti-Drug Authority. Guo, J., Hill, K. G., Hawkins, J. D., Catalano, R. F., & Abbott, R. D. (2002). A developmental analysis of sociodemographic, family, and peer effects on adolescent illicit drug initiation. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 838−845. Johnston, L. D., O'Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2006). Monitoring the future national survey results on drug use, 1975–2005, Volume 1 — Secondary School Students. NIH Publication, vol. 06-5883. Bethesda, MD: National Institute on Drug Abuse. Lithwick, H. (2003). Urbanization policy for indigenous peoples: A case study of Israel's Negev Bedouins. In I. Abu-Saad & D. Champagne (Eds.), The future of indigenous peoples: Strategies for survival and development (pp. 185−202). UCLA, Los Angeles: American Indian Studies Center. Olson, D. H., Portner, J., & Lavee, Y. (1985). FACES III. Family social sciences. St. Paul, MN: University of Minnesota.
Addictive Behaviors 33 (2008) 143 – 151
Short communication
Drug and alcohol use among the Bedouin of the Negev: Prevalence and psychosocial correlates Gary M. Diamond a,⁎, Aneese Farhat a , Mahmud Al-Amor b , Salman Elbedour c , Karni Shelef a , Rachel Bar-Hamburger b a
Department of Behavioral Sciences, Ben-Gurion University of the Negev, POB 653, Beer-Sheva, 84105, Israel b Israel Anti-Drug Authority, Cnafe Nesherim 7, POB 3985, Jerusalem, 91039, Israel c School of Education, Howard University. 2441 4th Street, NW, Washington, DC 20059, United States
Abstract The primary aim of this study was to estimate the prevalence of drug and alcohol use among the Bedouin of the Negev. A representative sample of 821 adults and 440 adolescents were surveyed using the Arabic version of the Israeli National Epidemiological Questionnaire. Almost 14% of adult Bedouins used alcohol and 11.1% used illicit drugs during the past year, with rates higher among individuals living in government settlements than those living in unrecognized traditional villages. Among adolescents, 21.9% used alcohol and 20.4% used drugs over the past year, with rates higher for high school students than for school attritters. Drug use was positively associated with being male, having a tolerant attitude toward drug use, the perception that drugs were not dangerous, being secular, low family cohesion and either low or high family adaptability. These data suggest that drug use is prevalent among the Bedouin of the Negev, particularly among adolescents, who report using drugs such as narcotics, cocaine, and hallucinogens at rates 3 to 8 times greater than Israeli Jewish secular students. School-based and family-based prevention and treatment programs may be most effective for this population. © 2007 Elsevier Ltd. All rights reserved. Keywords: Drugs; Alcohol; Bedouin; Survey; Israel
⁎ Corresponding author. Current address: Department of Psychology, Ben-Gurion University of the Negev, Be'er Sheva, Israel. Tel.: +972 8 647 2083; fax: +972 8 647 2932. E-mail addresses: [email protected] (G.M. Diamond), [email protected] (A. Farhat), [email protected] (M. Al-Amor), [email protected] (S. Elbedour), [email protected] (K. Shelef), [email protected] (R. Bar-Hamburger). 0306-4603/$ - see front matter © 2007 Elsevier Ltd. All rights reserved. doi:10.1016/j.addbeh.2007.04.028
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G.M. Diamond et al. / Addictive Behaviors 33 (2008) 143–151
1. Introduction The Bedouin of the Negev are Muslim Arabs who have inhabited the Negev desert since the fifth century CE and, today, number approximately 150,000. Traditionally organized into nomadic or semi-nomadic tribes, over the past half-century they have experienced rapid and dramatic transition, with half of the population being resettled into seven urban-style, government settlements. The forced move from traditional semi-nomadic life to underdeveloped urban settlements has had farreaching social and economic consequences, including decreased family cohesion, more densely populated living conditions, and high rates of unemployment and poverty (Abu-Saad, 2003; Lithwick, 2003), placing them at greater risk for drug use (Guo, Hill, Hawkins, Catalano, & Abbott, 2002). Results from the only previous study of drug use among Bedouin adults found that, indeed, drug use was higher than in the Israeli population at large, with those adults living in government settlements reporting marijuana and other drug use at rates two to three times greater than adults living in traditional, unrecognized villages (Abu-Saad, 1998). These findings, however, should be interpreted with caution since the sample did not include women. Recent findings from a subset of 250 Bedouin adolescents who participated in the latest National Epidemiological Study indicate that 12.7% of Bedouin high school students had used illicit drugs over the past year as compared to 10.3% of Jewish high school students. Furthermore, 10.8% of Bedouin students reported using other drugs, including narcotics, cocaine and hallucinogens — a rate almost four times higher than the rate for such drug use among their Jewish counterparts (Bar-Hamburger et al., 2005). Unexpectedly, Bedouin school attriters reported using illicit drugs at a substantially lower rate (7.7%) than did Bedouin high school students (12.7%). This finding is important in the light of the extremely high rate of school attrition (up to 70% by 12th grade) among Bedouin adolescents. More research utilizing larger, more representative samples and standardized instruments is needed. 2. Method 2.1. Sample and sampling procedure A total of 821 adults, age 19 or older, and 440 adolescents, between the ages of 14 and 18 years, were included in this survey. Both stratification and clustering sampling procedures were employed. The final sample of residents from government settlements was 66% male, with an average age of 26 (SD = 8.17) years. The final sample of participants from unrecognized villages was 65% male, with an average age of 26 (SD = 7.36) years. The adolescent sample was stratified according to educational status and included 295 high school students and 145 school attriters. Two high schools (out of nine) were randomly chosen, and then 3 classrooms from each grade (9th through 12th) at each school were randomly sampled. Fifty-two percent of the school students surveyed were boys, with an average age of 16 (SD = 1.36) years. School attriters were randomly sampled from various gathering places (e.g., marketplace, arcades), government sponsored after-school program for school attriters and via door-to-door surveying procedures. Seventy-nine percent of the school attriters surveyed were boys, with an average age of 17 (SD = 1.23) years.
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2.2. Assessors The questionnaires were administered by a group of 6 Bedouin college students, ranging in age from 18 to 25 years. Two of the assessors were women and 4 were men. 2.3. Data collection procedure Surveys were administered individually (except in school classrooms) and anonymously. All data were collected between the years of 2002 and 2003. 2.4. Measurements This study employed an abbreviated, Arabic version of the National Epidemiological Questionnaire (NEQ). The questionnaire includes demographic questions, questions regarding drug use, and two measures assessing respondents' attitudes (i.e., tolerance and perceived dangerousness) toward drug use. Both attitude measures have proven reliable and predicted drug use in previous studies (BarHamburger et al., 2005). In this study, the tolerance towards drugs measure evidenced an Alpha Chronbach of 0.80 for adolescents and 0.88 for adults, and the dangerousness measure evidenced an Alpha Chronbach of 0.91 for adolescents and 0.92 for adults. The NEQ also includes the short version of the Family Adaptability and Cohesiveness Environment Scale (Faces-III; Olson, Portner, & Lavee, 1985). The FACES-III measures two dimensions of family functioning — cohesion and adaptability. The psychometric properties of both subscales are good (Olson et al., 1985). In this study, the internal
Table 1 Past year prevalence rates (%) for each type of drug — adults Type of drug
Settlements
Villages
All adults
Any alcohol Wine Beer Liquor Any drugs Prescription medication Sleeping pills/sedatives Speed Cannabis Hashish Marijuana Other drugs Methadone Heroin/Opium Cocaine Crack L.S.D. Ecstasy PCP/Poppers
17.0 14.1 11.7 11.8 13.5 7.7 6.5 4.8 11.0 8.3 9.9 7.5 4.4 4.4 4.4 4.2 4.2 4.2 3.3
11.0 8.0 8.7 4.4 8.8 5.6 4.6 3.2 5.0 3.8 4.6 3.1 1.1 0.7 1.4 0.9 1.2 1.2 1.0
13.9 11.0 10.2 8.1 11.1 6.6 5.5 4.0 7.5 6.0 7.2 5.3 2.7 2.6 2.9 2.6 2.7 2.7 2.2
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Table 2 Past year prevalence rates (%) according to drug and demographics — adults Any alcohol
Any drug
Cannabis
Prescription drugs
Other drugs
N
Gender Male Female χ2
9.0 4.1 14.34⁎⁎⁎
7.7 2.7 17.67⁎⁎⁎
5.8 1.3 19.69⁎⁎⁎
4.3 2.2 5.13⁎
3.3 1.6 4.28⁎
471 253
Age 18–24 25–34 35 + χ2
13.6 14.7 12.7 n.s.
10.4 12.7 10.3 n.s.
6.6 8.2 8.9 n.s.
5.9 7.5 7.3 n.s.
5.4 4.1 7.7 n.s.
411 293 114
Religiosity Devout Practicing Secular χ2
4.4 10.9 57.2 201.7⁎⁎⁎
5.6 10.5 30.4 55.0⁎⁎⁎
3.7 5.4 23.4 51.29⁎⁎⁎
4.6 6.0 16.0 17.73⁎⁎⁎
3.1 4.9 11.9 14.97⁎⁎⁎
357 332 114
⁎p b 0.05, ⁎⁎p b 0.01, ⁎⁎⁎p b 0.001.
Table 3 Past year prevalence rates (%) according to cognitive and family variables — adults Any alcohol
Any drug
Cannabis
Prescription drugs
Other drugs
N
1.0 7.9 33.4 133.48⁎⁎⁎
1.8 7.6 24.1 75.65⁎⁎⁎
0.8 3.7 17.6 67.80⁎⁎⁎
1.0 4.9 14.1 41.89⁎⁎⁎
0.4 2.7 12.5 46.48⁎⁎⁎
289 255 273
Dangerousness Low Moderate High χ2
29.3 11.8 1.2 93.82⁎⁎⁎
23.4 8.4 0.7 76.86⁎⁎⁎
18.2 3.0 0.0 79.26⁎⁎⁎
14.2 6.1 0.3 42.20⁎⁎⁎
11.0 4.1 0.3 32.85⁎⁎⁎
279 257 278
Cohesiveness Low Middle High χ2
18.3 16.3 6.7 16.40⁎⁎⁎
14.6 11.6 7.4 7.16⁎
11.0 6.9 4.5 8.10⁎
8.8 7.3 4.2 n.s.
11.0 6.9 4.5 8.10⁎
272 281 258
Adaptability Low Middle High χ2
18.1 9.8 13.5 8.36⁎
13.9 9.0 10.4 n.s.
10.6 5.4 6.7 6.31⁎
8.5 5.5 5.6 n.s.
6.2 4.0 5.3 n.s.
293 286 228
Tolerance Low Moderate High χ2
⁎p b 0.05, ⁎⁎p b 0.01, ⁎⁎⁎p b 0.001.
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consistency estimate for the cohesion subscale was α = 0.75 and for the adaptability scale α = 0.65 for the adolescent sample, and 0.87 for the cohesion scale and 0.71 for the adaptability scale for the adult sample. 2.5. Statistical analyses Prevalence rates were calculated in frequencies. The association between drug use and demographic/ psychosocial variables was calculated using Chi-Square analyses. 3. Results 3.1. Past year prevalence rates of drug and alcohol use, and their psychosocial correlates, among adult Bedouins Over the past year, 13.9% of adult Bedouins reported using alcohol and 11.1% reported using at least one type of illicit substance (see Table 1). Adults living in government settlements reported higher rates of alcohol use, illicit drug use, cannabis use, and other drug use than those living in traditional, unrecognized villages. Across the entire adult sample, males used alcohol and drugs at a higher rate than did females (see Table 2). While there was no relation between age and alcohol or drug use, there was an association with religiosity, with those adults identifying themselves as secular reporting the highest rates of alcohol and drug use (see Table 2). The more tolerant adults' attitude toward alcohol and drug use, and the less dangerous they perceived drugs and alcohol to be, the higher their rate of reported alcohol and drug use (see Table 4 Past year prevalence rates (%) for each type of drug — adolescents Type of drug
Students (N = 295)
School attriters (145)
All adolescents (N = 440)
Any alcohol Wine Beer Liquor Any drugs Prescription medication Sleeping pills/sedatives Speed Cannabis Hashish Marijuana Other drugs Methadone Heroin/Opium Cocaine Crack L.S.D. Ecstasy PCP/Poppers
23.3 17.4 18.3 19.0 27.7 19.6 15.5 16.4 18.0 16.4 16.4 25.4 17.8 16.9 15.8 15.9 16.4 15.9 14.0
20.5 13.7 15.7 13.7 13.1 10.7 9.4 5.8 12.7 10.7 9.2 9.9 7.0 5.6 5.6 3.7 7.0 5.5 3.3
21.9 15.5 17.0 16.3 20.4 15.2 12.5 11.1 15.4 13.5 12.8 17.6 12.4 11.3 10.7 9.8 11.7 10.7 8.7
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Table 5 Past year prevalence rates (%) according to demographics — adolescents Any alcohol
Any drug
Cannabis
Prescription drugs
Other drugs
N
Gender Male Female χ2
31.5 12.3 20.58⁎⁎⁎
26.8 12.6 12.47⁎⁎⁎
22.0 8.1 14.34⁎⁎⁎⁎
19.5 9.2 8.01⁎⁎⁎
21.7 11.9 7.07⁎⁎⁎
267 170
Age −14 15–16 17+ χ2
23.7 28.6 15.9 9.72⁎⁎
22.0 26.8 13.8 10.61⁎⁎
19.0 21.9 8.5 15.84⁎⁎⁎
22.0 21.1 8.1 15.94⁎⁎⁎
22.0 23.0 10.8 12.05⁎⁎
29 165 258
Religiosity Devout Practicing Secular χ2
16.8 23.1 39.4 11.22⁎⁎
19.0 14.5 47.7 26.20⁎⁎⁎
13.0 10.3 45.3 37.86⁎⁎⁎
13.8 11.2 39.0 22.96⁎⁎⁎
18.0 11.4 41.6 24.91⁎⁎⁎
192 205 46
⁎p b 0.05, ⁎⁎p b 0.01, ⁎⁎⁎p b 0.001.
Table 2). Family environment was also associated with alcohol and drug use: the more cohesive the family environment, the lower the rate of adults' alcohol and drug use. The relation between family adaptability and alcohol and marijuana use was curvilinear, with adults from moderately adaptable (flexible) homes reporting lower rates of alcohol and marijuana use than adults living in low and highly adaptive families. Family adaptability was not associated with the use of other drugs (see Table 3). 3.2. Past year prevalence rates of drug and alcohol use, and their psychosocial correlates, among adolescents Almost 22% of Bedouin adolescents reported using alcohol and 20.4% reported using at least one type of illicit substance over the past year (see Table 4). While school attenders and attriters reported using alcohol at practically equal rates, school attenders reported using illicit drugs, including narcotics and hallucinogens, at over twice the rate of school attriters. Across the entire sample of adolescents, males used alcohol and drugs at higher rates than did females (see Table 5). Across all types of drugs and alcohol, usage rates were higher among 14–16 year olds than they were among 17–18 year olds. Furthermore, adolescents who identified themselves as coming from a devout or traditional Muslim home used illicit drugs and alcohol at lower rates than those adolescents who reported coming from secular homes (see Table 5). The more tolerant the adolescent's attitude toward alcohol and drug use, and the less dangerous the adolescent perceived alcohol and drugs to be, the higher their rate of alcohol and drug use (see Table 6). Also, the more cohesive the family environment, the lower the rate of adolescents' alcohol use (see Table 6). The relationship between family adaptability and drug use, however, was curvilinear, with those adolescents coming from moderately adaptable (flexible) homes reporting the
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149
Table 6 Past year prevalence rates (%) according to cognitive and family variables — adolescents Any alcohol
Any drug
Cannabis
Prescription drugs
Other drugs
N
Tolerance Low Moderate High χ2
6.1 28.0 34.6 41.05⁎⁎⁎
7.0 21.1 35.9 39.20⁎⁎⁎
2.5 16.9 29.8 44.39⁎⁎⁎
3.4 17.0 28.3 36.55⁎⁎⁎
4.7 17.9 32.6 41.13⁎⁎⁎
166 134 147
Dangerousness Low Moderate High χ2
28.5 23.6 10.8 13.76⁎⁎⁎
26.0 21.6 10.3 11.84⁎⁎
20.1 17.7 5.4 14.60⁎⁎⁎
18.2 17.7 6.5 9.75⁎⁎
21.5 18.5 9.6 7.91⁎
154 154 136
Cohesiveness Low Middle High χ2
27.4 24.3 13.2 9.66⁎⁎
26.1 20.2 13.8 7.34⁎
22.4 15.1 8.3 11.75⁎⁎
23.4 14.4 8.3 13.06⁎⁎
24.1 16.9 11.0 8.66⁎⁎
142 148 156
Adaptability Low Middle High χ2
18.0 23.6 26.7 n.s.
20.6 13.9 26.9 7.39⁎
15.4 8.5 21.8 9.39⁎⁎
15.9 11.1 18.8 n.s.
16.9 12.4 23.9 6.34⁎
166 140 138
⁎p b 0.05, ⁎⁎p b 0.01, ⁎⁎⁎p b 0.001.
lowest rate of drug use. There was no relation between family adaptability and alcohol use (see Table 6). 4. Discussion Overall, adult Bedouins reported using illicit drugs at a rate (11%) similar to that found among the general Israeli adult population, though they reported using certain drugs – such as narcotics, cocaine and hallucinogens – at a rate more than twice that found among their Israeli counterparts (Bar-Hamburger et al., 2005). As expected, adult Bedouins reported a substantially lower rate of alcohol use than their Israeli peers, most likely due to Islam's explicit prohibition of alcohol use (Al-Krenawi, Graham, & Sehwail, 2002). Also as expected, Bedouins living in government settlements used drugs and alcohol substantially more than those living in unrecognized, traditional villages. This finding is consistent with findings from the Abu-Saad (1998) study and may be attributable to the stress, family and social disintegration, and unemployment associated with the move from an agrarian, traditional, ritualized lifestyle to the more isolated, less structured, and more anonymous lifestyle found in the larger and more densely populated government settlements. Approximately 22% of Bedouin adolescents reported using alcohol and approximately 20% reported using at least one type of illicit substance over the past year. The prevalence rate for illicit drugs was over
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twice the rate found among the general, primarily Jewish, Israeli public high school population (BarHamburger et al., 2005). In fact, Bedouin high school students reported using drugs such as narcotics, cocaine and hallucinogens at rates 3 to 8 times greater than Jewish secular students. This finding is both worrisome and consistent with findings from the most recent National Epidemiological Survey (BarHamburger et al., 2005). Interestingly, and also consistent with findings from the most recent National Epidemiological study, the rate of drug use among Bedouin school attriters appears to be lower than among school attenders. In fact, Bedouin high school students used drugs such as narcotics, cocaine and hallucinogens at two and a half times the rate of attriters. These findings are divergent from results from studies examining the general Israeli population (Bar-Hamburger et al., 2005) and North American samples (Johnston, O'Malley, Bachman, & Schulenberg, 2006), which indicate that adolescents not in school are particularly at risk. Whereas school attrition among the general Israeli population and other Western cultures typically reflects failure in the socialization process and is associated with poor academic functioning, psychological symptoms, and low parental monitoring, among the Bedouin, having adolescents remain at home to help with agricultural and family responsibilities is culturally normative. In this context, the majority of Bedouin adolescents who are not in school may actually be engaged in productive activities and may be subjected to heightened parental involvement and monitoring. Drug use among both adult and adolescent Bedouin was associated with a number with a number of psychosocial factors. In general, lower drug use was associated with being female, greater religiosity, less tolerant attitudes toward drugs, the perception of drugs being dangerous, greater family cohesion and moderate levels of family adaptability. These findings must be interpreted in the context of a number of methodological limitations. Most importantly, the measure did not include a valid index of response veracity. Consequently, we were unable to estimate what percentage of respondents may have over-reported their drug use. Nor was there any method to detect potential underreporting. In a closed society such as the Bedouin, stigma could potentially lead members to deny the use of drugs — even when assured that their reports are unidentifiable. Despite these limitations, the findings from this study are based on the most representative and reliable data collected to date on drug use among the Bedouin of the Negev. They indicate the dire need for extensive prevention and treatment programs, particularly school-based and family-based programs. Acknowledgement This study was supported by a grant from the Israel Anti-Drug Authority. We would like to acknowledge the contributions of Lilly Noiman and Giora Rahav to this project. A full report of these findings can be obtained by contacting the first author. References Abu-Saad, I. (1998). The influence of settlement on substance use and abuse among nomadic populations in Israel and Kenya (Project code number 92-2.1). Scientific report: Israel development research program. Abu-Saad, I. (2003). Bedouin Arabs in Israel between the Hammer and the Anvil: Education as a Foundation for Survival and Development. In I. Abu-Saad & D. Champagne (Eds.), The future of indigenous peoples: Strategies for survival and development (pp. 103−120). UCLA, Los Angeles: American Indian Studies Center.
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Al-Krenawi, A., Graham, J. R., & Sehwail, M. A. (2002). Alcohol and drug abuse from an Islamic Perspective: Implications for intervention. In R. Israloqitz, M. Afifi, & R. Rawson (Eds.), Drug problems: Cross-cultural policy and program development. Connecticut, USA: Auburn House. Bar-Hamburger, R., Ezrahi, Y., Steinberg, D., Roziner, A., Ovadia, N., & Moshe, T. (2005). Drug and alcohol use among residents of Israel 2001: Epidemiological study VI. Jerusalem: Israel Anti-Drug Authority. Guo, J., Hill, K. G., Hawkins, J. D., Catalano, R. F., & Abbott, R. D. (2002). A developmental analysis of sociodemographic, family, and peer effects on adolescent illicit drug initiation. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 838−845. Johnston, L. D., O'Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2006). Monitoring the future national survey results on drug use, 1975–2005, Volume 1 — Secondary School Students. NIH Publication, vol. 06-5883. Bethesda, MD: National Institute on Drug Abuse. Lithwick, H. (2003). Urbanization policy for indigenous peoples: A case study of Israel's Negev Bedouins. In I. Abu-Saad & D. Champagne (Eds.), The future of indigenous peoples: Strategies for survival and development (pp. 185−202). UCLA, Los Angeles: American Indian Studies Center. Olson, D. H., Portner, J., & Lavee, Y. (1985). FACES III. Family social sciences. St. Paul, MN: University of Minnesota.