UC San Diego

BackgroundThe political determinants of health are pronounced in the Palestinian community, particularly among Palestinian adolescents, due to living under Israeli military occupation. Understanding the consequences of such determinants that contribute to stress as structural violence, forced displacement, discrimination, and marginalization is vital to grasp its role on the health and health management of Palestinian adolescents living in Palestine. This dissertation examines the relationship of psychosocial stressors on Palestinian adolescent blood pressure and the acceptability of mobile health interventions in the region. Methods A multi-method cross-sectional study was conducted in Palestinian adolescents, parents, and family members living in refugee camps, cities, and villages across Palestine. A sample of 720 Palestinian adolescents were sampled through schools and centers across Palestine from November 2022 to January 2023. Blood pressure, anthropometric, and psychosocial measures via surveys were collected. Psychometric and ordinal logistic regression analyses were conducted to assess the relationship between each psychosocial factor, refugee status, and blood pressure. Moreover, qualitative interviews and analyses were conducted among 13 Palestinian families to assess the acceptability of mobile health adoption for health management in Palestine. Results The overall prehypertension and hypertension prevalence for this participant sample was three and two and half times the global average. There was no significant association between refugee status and prehypertension and hypertension categories in unadjusted models or models adjusting for age and sex. However, there were significant inverse relationships between refugee status, prehypertension and hypertension for females and males. Female refugees had higher odds of higher blood pressure than non-refugees after adjusting for age. In contrast, male refugees had lower odds of having higher blood pressure than male non-refugee counterparts. As a result, our findings suggest sex- specific differences among refugee and non-refugee groups when assessing blood pressure levels (Chapter 1). Chapter 2 demonstrated that high blood pressure levels were associated with different psychosocial factors differing by encampment experience. Bivariate regression analyses showed that psychosocial factors as settler colonial violence to friends/neighbors, tear gas/bombs, and depression symptoms were inversely related dependent on refugee status i.e., an increase of settler colonial violence to friends/neighbors, tear gas/bombs, and depression symptoms were related to higher odds of high blood among non-refugee groups and lower blood pressure in refugee groups. Moreover, an increase of cultural resistance resilience and adaptive coping were related to lower blood pressure in refugee groups. Further, multivariate regression analysis showed an increase of settler colonial violence to the individual’s home was associated with higher blood pressure among refugees. Chapter 3 showed that there are potential benefits of mobile health adoption for self-management of stress and diverse health outcomes among adults and youth with health conditions as cardiovascular disease and diabetes; However, the adaptation of interventions prior to implementation are crucial to account for contextual factors to avoid introducing risk of harm to the Palestinian population. Conclusion Our research demonstrated that relationship of higher blood pressure levels among Palestinian adolescents varied by refugee status, types of settler colonial violence, and the adoption of cultural resistance. Further, our research demonstrated that living under Israeli military occupation challenges the acceptability of adoption of mobile health interventions to manage health outcomes as non-communicable diseases in Palestine; Such mobile health interventions require a cultural, historical, and geopolitical adaptation of interventions alongside working with local stakeholders prior to implementation to account for contextual factors to avoid placing the population at risk of harm. Future longitudinal research must consider exposures experienced living in encampment among Palestinian adolescents over a lifespan to understand how psychosocial factors relate cardiovascular health and guide future overall health intervention implementation.