Abstract
BACKGROUND: Exposure to political violence, which pervades many parts of the Middle East and Northern African (MENA) region, is a key potential factor behind the rising rates of risky behaviors among youth, such as drug use, alcohol use, and sexual activity. Theory and empirical work on youth elsewhere suggests that individual characteristics, mental health, and youths' future orientation play a role in such behaviors. It is possible that political violence impacts behavior in part through its effects on these factors, in particular mental health. However, very little is known about the determinants of youth risk behavior in the region. Understanding the determinants will help MENA countries to deal with emerging public health threats as well as risks to youth health and well-being resulting from engagement in risky behavior. We examined determinants of risky behavior among Palestinian youth in the West Bank and East Jerusalem. METHODS: We employed structural equation modeling using a 2014 nationally representative data from the Palestinian Youth Health Risk Study to examine the factors associated with engagement of youth ages 18-24 (N = 1449) in risky behaviors. RESULTS: Personal experience of political violence was the strongest direct predictor of engagement in interpersonal violence (β = 0.21, p = 0.00) and substance use (β = 0.21, p = 0.00). With respect to indirect effects, global distress mediates the impact of witnessing and vicariously experiencing violence on the three outcomes. However, no association was found between personally experiencing political violence and global distress. The study also identified several individual characteristics, such as religiosity, that may be protective against risky behavior. Females are less likely to engage in risky behavior than males, despite experiencing higher levels of global distress. CONCLUSIONS: The study is the first to use population-based data to test the effects of exposure to political violence on key risky health behaviors of Palestinian youth, a population facing protracted conflict and hardship for which solutions remain elusive. The findings suggest the need for customized interventions to target male and female Palestinians at an early age to develop their coping skills in dealing with violence and distress. TRIAL REGISTRATION: Not applicable.