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Eur J Prev Cardiol. 2015 Apr;22(4):458-67. doi: 10.1177/2047487314520924. Epub 2014 Jan 27.

Change in health behaviours following acute coronary syndrome: Arab-Jewish differences.

Author information

  • 1Hebrew University and Hadassah Medical Center, Jerusalem, Israel Clalit Research Institute, Tel-Aviv, Israel Meir Medical Center, Kfar-Saba, Israel
  • 2Bar-Ilan University, Ramat-Gan, Israel.
  • 3Clalit Research Institute, Tel-Aviv, Israel New York University, New York, USA.
  • 4Meir Medical Center, Kfar-Saba, Israel.
  • 5Hebrew University and Hadassah Medical Center, Jerusalem, Israel.



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.


Prospective cohort study.


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.


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).


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.

© The European Society of Cardiology 2014 Reprints and permissions:


Acute coronary syndrome; Arabs; Jews; cardiac prevention; ethnicity; exercise; gender; health-promoting behaviours; rehabilitation program; smoking

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