Knowledge, Attitudes, and Behavior Regarding Health and Environment in an Israeli Community: Implications for Sustainable Urban Environments and Public Health

Abstract

Over the past two decades, public health researchers have increasingly emphasized the need to adopt a new, comprehensive approach to the environment that addresses social and spatial aspects of urban life affecting public health in urban areas. Urban authorities can reduce environmental and climate change damages by promoting green construction and clean energy production, establishing recycling stations, encouraging residents to change their consumption and eating patterns, and more. Municipal authorities in Ashkelon, Israel, like their counterparts around the world, recognize the critical importance of participating in global efforts to address the climate crisis. In this context, we conducted a survey to examine the associations between knowledge, attitudes, and behavior regarding health and the environment among Ashkelon residents. A total of 322 participants from the city’s adult population completed an online questionnaire. Our findings indicate that Ashkelon residents understand the connection between the environment and human behavior and have a positive attitude toward preserving the environment. However, not all the city’s residents exhibit pro-environmental behavior, and not all pro-environmental facilities are accessible to all city residents. Significant positive connections were found between knowledge, attitudes, pro-environmental behavior, and accessibility to facilities. Participants who kept pets at home demonstrated more pro-environmental knowledge, attitudes, and behavior than those who did not have pets. Strengthening positive attitudes towards the environment is essential if individuals are to acquire knowledge and understand how to maintain a healthy environment. To achieve this end, extensive public education on environmental and climate change issues is needed, and the city environment should promote a healthy lifestyle while preserving the environment.

1. Introduction

During the past two decades, public health researchers have emphasized the need to adapt a more comprehensive approach to public health for urban areas, one that addresses the social and spatial aspects of living in a city that affect public health [1]. The critical importance of such an approach became evident during the COVID-19 pandemic, when local authorities worldwide actively participated in national efforts to mitigate the pandemic. Similarly, in the context of the climate crisis, municipal authorities have the ability and authority to enable and empower residents to minimize environmental damage [2]. Cities are hubs of human activity associated with energy consumption and resource usage. As a result, they are a source of considerable greenhouse gas emissions [3]. The environment can also be adversely affected by lifestyle choices and the impacts of increases in living standards, such as increased meat consumption, traveling by private vehicles, leisure boating, flights, and more [4]. Increases in living standards can give rise to the widespread availability of inexpensive clothing from the Far East that is discarded after a season, thus generating vast quantities of waste in the country [5].

Sustainable cities are “green” cities that aim to reduce their environmental impact and promote sustainable consumption and production policies and behaviors that are carefully tailored to reflect a country’s existing conditions, taking account of diverse cultural, social, and geographical factors. Green city residents should be encouraged to become committed to the common goal of sustainability and to develop new habits that are less harmful to the environment [6]. Therefore, urban residents need to agree and collaborate about a range of activities, including promoting waste recycling and reduction, using renewable energy, encouraging local purchasing, reducing transportation use, increasing green spaces, and raising awareness among the population [7].

Israel has a national program, “Efsharibari” (healthy is possible), seeking to promote health and facilitate the integration of good nutrition, a healthy lifestyle, and physical activity into people’s behaviors. The program, involving governmental bodies, municipal authorities, the private sector, and volunteer organizations [8], was founded following a 2011 government decision to implement a national program promoting an active lifestyle, based on the recommendations of the World Health Organization. Many cities in Israel, including Ashkelon, have joined the “Healthy and Sustainable Cities” network as part of the Efsharibari program. “Healthy and Sustainable Cities” is a global movement whose vision is to lead to improvements in life, health, and sustainability at the local level. Every authority joining the network commits to adopting action plans to promote health and work towards sustainable development in order to create a better quality of life. Joining the network of healthy and sustainable cities is a clear statement of the municipality of Ashkelon’s intent to improve the quality of life for residents.

With widespread agreement that human activities have caused considerable damage to the environment [9], a consensus has emerged that increased atmospheric carbon dioxide levels have been caused by human activity [10]. In recent years, various international regulations have been implemented to preserve environmental quality. These regulations employ different innovative technologies to minimize human impact on the environment [11]. For example, sustainable nutrition initiatives can assist people in developing environmental values and increasing their commitment to preserving the environment. Local communities that protect the environment and facilitate the production of local and sustainable food can foster long-term prosperity and help enhance environmental restoration and preservation [12].

In their survey of 361 college students in Israel regarding their knowledge, behavior, and attitudes regarding the environmental impact caused by the livestock industry, Dopelt et al. [5] found that the students were unaware that the food they consumed had an environmental impact, particularly regarding animals. The study’s findings also emphasize the importance of instilling environmental understanding and knowledge in order to achieve behavioral change [5].

Various studies have found that people hold misconceptions about the long-term effects of climate change and still do not fully understand the need to take personal responsibility or the potential impact of individuals’ actions [13]. However, several studies have shown a strong correlation between attitudes toward and concern about climate change and environmental behavior. Some studies even indicate that positive attitudes and concern about climate change can partially influence how knowledge is expressed in pro-environmental behavior [14,15,16].

Cities have the potential to reduce environmental harm by promoting green construction, producing clean energy, increasing the use of recycling bins, and educating the public on changing their consumption and eating patterns [17]. Like many cities worldwide, the municipality of Ashkelon understands the need to participate in global efforts to address the climate crisis. Ashkelon has some unique characteristics in relation to climate change: it is a coastal city in the Southern District of Israel on the Mediterranean coast, suffering from floods after heavy rains and is probably likely to suffer in the coming decades due to sea level rise and being home to several major polluting facilities—the northern terminus for the Trans-Israel pipeline, which brings petroleum products from Eilat to an oil terminal at the port, and an energy power plant operated by coal, though gradually moving to work on gas after years of deliberations and protest due to air pollution impact. In addition, Ashkelon is also home to the largest seawater reverse-osmosis (SWRO) desalination plant in the world, together with some other similar facilities, allowing Israel to achieve the highest level of use of desalinated water (about 85% of the country’s drinkable water is produced through desalination).

In Ashkelon, various activities are carried out regarding environmental promotion, but since no needs assessment or attitudes and behaviors survey have been conducted, it is possible that these activities are not relevant. Prevention programs could be better adjusted by investigating perceptions and environmental behavior. Therefore, we conducted this study to examine whether there is a connection between knowledge, attitudes, and behavior regarding the environment among the residents of Ashkelon, Israel. Moreover, we examine the relationships between the level of accessibility to facilities beneficial to the environment or public health with knowledge, attitudes, and reported behavior. Furthermore, we try to identify significant predictors of pro-environmental behavior. We also sought to develop intervention plans based on the findings. No similar survey has ever been conducted in the city of Ashkelon.

2. Materials and Methods

2.1. Participants and Procedures

This cross-sectional study involved 322 participants from the adult population in Ashkelon, Israel. At the end of 2021, there were approximately 51,300 households in Ashkelon, with close to 150,000 residents [18]. An online questionnaire was programmed using Qualtrics XM survey software (Qualtrics, Provo, UT, USA). On 13 March 2023, a link to the questionnaire was distributed on social networks (neighborhood WhatsApp and Facebook groups), along with details about the research project. We do not know how many potential participants were exposed to the survey link. We estimate it to be a few hundred. Individuals aged less than 18 years were asked not to respond to the questionnaire. A reminder was sent to the groups one month later, and the survey was closed on 15 May 2023. According to the software data, the average time to complete the questionnaire was 6.8 min. There were 381 entries recorded, but only 322 participants completed the questionnaire, resulting in a completion rate of 85%. At the beginning of the questionnaire, the purpose of the study was explained. Completion of the questionnaire constituted informed consent to participate in the study. None of the questions were defined as mandatory. The data file was accessible only to the researchers and was protected by a password on the computer. Participants could not be identified, as no identifying information was collected as part of the survey.

2.2. Research Tool

An online, closed, anonymous, self-reporting questionnaire based on a literature review and various similar questionnaires [3,5,14,19] was used. We gathered questions that suited the research purpose from several studies that were similar to the current study, as we did not find a complete questionnaire that precisely matched the study objectives. To validate the questionnaire, it was first completed by eight staff members at Ashkelon Academic College who did not live in the city of Ashkelon. Five questions were then corrected based on written comments from these individuals. In the next step, the questionnaire was validated by two sustainability and public health experts using a content validation method. The questionnaire comprised six parts:

• Demographic data—This section contained eleven questions regarding participants’ gender, age, marital status, number of people in their household, number of children aged under 18 years old, religiosity, education, country of birth, dietary habits, socioeconomic status, and neighborhood of residence.
• Attitudes—This section contained ten statements (see Table 2). Participants were asked to indicate their level of agreement with each statement on a Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). The variable was constructed by calculating the mean score for each participant after reversing the scales for statements 3 and 9, with a higher score indicating a more positive attitude toward the environmental protection.
• Knowledge—This section of the questionnaire contained ten statements (see Table 3). Participants were asked to indicate their level of agreement with each statement on a Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). The variable was constructed by calculating the mean score for each participant, with a higher score indicating a higher level of knowledge.
• Behavior—This section of the questionnaire had ten statements (see Table 4). Participants were asked to indicate their level of agreement with each statement on a Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). The variable was constructed by calculating the mean score for each participant after reversing the scale for statement 6, with a higher score indicating more environmentally friendly behavior.
• Accessibility of facilities beneficial to the environment or public health (hereafter referred to as “facilities”)—Participants were asked to indicate whether the following facilities were available near their residence: clothing recycling stations, battery recycling stations, paper recycling bins, plastic and glass recycling bins, walking paths/trails, parks and playgrounds, and fitness facilities. The variable was constructed by counting the positive responses. The variable could vary between 0 and 7, with a higher score indicating accessibility to more facilities near the participant’s residence.
• Participants were also asked an open-ended question: “In your opinion, how can the municipal authority contribute to environmental conservation?”.

2.3. Data Analysis

The data were imported from the survey software and analyzed in SPSS v. 26 (IBM, Armonk, NY, USA). Relationships between the variables were examined using Pearson or Spearman correlations. Differences between groups were tested using independent-samples t-tests. A multiple linear regression model was used to predict environmental behavior. The model included variables that have been found to be associated with environmental behavior in univariate analyses. All reported p-values were based on two-sided tests and were considered significant when the values were less than 0.05.

3. Results

3.1. Sample Characteristics

Of the total 322 individuals participating in the study, 79% were women and 75% were in a relationship. Most of the participants were Israeli-born (70%), secular (57%), and with an academic education (54%). Most defined themselves as “omnivores” (88%), and 60% currently owned or had previously owned a pet. Participants’ ages ranged from 18 to 83 years, with the average age being 41.48 ± 13.74. Participants’ characteristics are shown in

Table 1. Participants’ characteristics.

Characteristic	n	%
Male	69	21
Female	253	79
Marital status:
Married, living with a partner	242	75
Single	48	15
Divorced/separated/widowed	32	10
Number of people living in the household:
Living alone	30	9
2 people	87	27
3–4 people	105	33
4 or more people	100	31
Have children under the age of 18	173	54
Level of religiosity:
Secular	182	57
Traditional	85	26
Religious	54	17
Level of education:
High school	57	18
Vocational high school	91	28
Higher education	173	54
Nutrition:
Omnivore	285	88
Vegetarian/vegan	37	12
Currently own or have previously owned a pet	191	60
Country of birth:
Israel	226	70
Former USSR countries	74	23
Other	22	7

.

3.2. Attitudes

The distribution of responses to statements that examined attitudes are presented in

Table 2. Distribution of responses to the attitudes questionnaire.

Statement	Weakly Agree (%)	Moderately Agree (%)	Strongly Agree (%)	Don’t Know (%)	Mean ± SD 1
1. It is important to preserve the quality of the environment	2	3	94	1	4.67 ± 0.66
2. Products made from recyclable materials should be used, even if they are more expensive	15	49	35	1	3.52 ± 0.97
3. The amounts of waste do not affect me directly *	26	24	48	2	3.36 ± 1.26
4. I feel uncomfortable producing plastic waste	12	27	60	1	3.68 ± 1.03
5. If I had more knowledge on the subject, I would incorporate environmental considerations into my food choices	10	18	72	0	4.03 ± 1.09
6. It is important to me to use up leftover food	12	16	71	1	3.86 ± 1.06
7. I am aware of the amount of waste my household produces	23	22	54	1	3.47 ± 1.17
8. It is important to me that the products I consume are produced in a way that preserves the rights of the animals	11	15	72	2	3.96 ± 1.04
9. The general concern for environmental problems [is not] excessive *	15	16	67	2	3.90 ± 1.28
10. I think that human behavior affects climate change	3	8	87	2	4.53 ± 0.80

¹ The mean was calculated without including the “I don’t know” option; SD, standard deviation. * Contrasting questions: the data are presented in reverse rank order.

. The categories were combined as follows: responses of 1 and 2 were combined into the category “weakly agree”, responses of 3 alone represented “moderately agree”, and responses of 4 and 5 were integrated into the category “strongly agree”. The internal consistency of this section was α = 0.70.

To construct the attitudes variable, we calculated the mean response of each participant with the “I don’t know” option excluded and after reversing the scale for statements 3 and 9. The mean value of the variable was 3.89 (SD = 0.52).

3.3. Knowledge

The distribution of responses to statements that examined the level of knowledge is presented in

Table 3. Distribution of responses to the knowledge questionnaire.

Statement	Weakly Agree (%)	Moderately Agree (%)	Strongly Agree (%)	Mean ± SD
1. I understand the connection between the environment and human health	2	21	77	3.97 ± 0.75
2. I know how to choose healthy food	21	33	46	3.35 ± 0.99
3. I know how waste is recycled	45	26	29	2.74 ± 1.24
4. I know the damage that plastic causes to the environment	19	32	49	3.48 ± 1.02
5. I know the damage caused to the environment by the livestock industry	38	27	35	2.99 ± 1.15
6. I know what is meant by the term “zero waste”	49	30	21	2.56 ± 1.22
7. I know what is meant by the term “One Health”	47	34	19	2.55 ± 1.16
8. Humans are primarily responsible for climate change	8	18	74	3.82 ± 0.86
9. I understand how much the climate crisis affects health	7	24	69	3.78 ± 0.83
10. You can save electricity and reduce environmental pollution	11	34	55	3.61 ± 0.91

. The categories were combined as follows: responses of 1 and 2 were integrated into the category “weakly agree”, responses of 3 alone represented “moderately agree”, and responses of 4 and 5 were combined into the category “strongly agree”. The internal consistency of this section was α = 0.82.

To construct the knowledge variable, we calculated the mean response of each participant. The mean value of the variable was 3.28 (SD = 0.63).

3.4. Behavior

The distribution of responses to statements that examined behavior is presented in

Table 4. Distribution of responses to the behavior questionnaire.

Statement	Weakly Agree (%)	Moderately Agree (%)	Strongly Agree (%)	Don’t Know (%)	Mean ± SD 1
1. Uses environmentally friendly products	12	29	38	21	3.45 ± 0.98
2. Puts plastic in the recycling bins	37	20	37	6	2.98 ± 1.46
3. Uses reusable cloth bags/baskets	15	13	79	3	3.95 ± 1.21
4. Considers installing solar panels in the house/building	35	12	21	32	2.61 ± 1.42
5. Make sure to buy only what is needed	10	18	69	3	3.97 ± 1.08
6. [No] ordering/buying home-prepared food *	16	35	47	2	3.39 ± 1.04
7. Eats family meals at least three times a week	17	21	59	3	3.60 ± 1.11
8. Household members usually eat vegetables and fruits	3	13	81	3	4.22 ± 0.79
9. Tries to consume less chicken and meat products	37	36	23	4	2.86 ± 1.19
10. Considers switching to a vegetarian or vegan diet	66	9	18	7	2.13 ± 1.39

¹ The mean was calculated without including the “I don’t know” option. * Contrasting questions: the data are presented in reverse rank order.

. The categories were combined as follows: responses of 1 and 2 were combined into the category “weakly agree”, responses of 3 alone represented “moderately agree”, and responses of 4 and 5 were integrated into the category “strongly agree”. The internal consistency of this section was α = 0.72.

To construct the behavior variable, we calculated the mean response of each participant without the “I don’t know” option and after reversing the scale for statement 6. The mean value of the variable was 3.35 (SD = 0.59).

3.5. Accessibility of Facilities near Participants’ Place of Residence

The participants were asked about the proximity to their residence of seven types of facilities. Figure 1 shows the percentages of respondents who stated that the given facility was available near their home.

To construct the variable for the accessibility of facilities near participants’ place of residence, we counted the positive responses from each participant. The variable ranged from 3 to 7, with an average of 4.13 (SD = 1.59).

3.6. Relationships between the Variables

Significant, positive, and strong relationships were found between participants’ level of knowledge and their attitudes and reported behavior (r_p = 0.31, p < 0.001; r_p = 0.40, p < 0.001, respectively); that is, the higher a participant’s level of knowledge, the more positive their attitude to the environment and the more pro-environmental their reported behavior. Similarly, a significant, positive, and strong relationship was found between participants’ reported attitudes and behavior (r_p = 0.45, p < 0.001). The more positive a participant’s attitude to the environment, the more pro-environmental their reported behavior. Significant, positive relationships were also found between participants’ level of accessibility to facilities and their knowledge, attitudes, and reported behavior (r_p = 0.15, p < 0.01; r_p = 0.25, p < 0.001; r_p = 0.23, p < 0.001, respectively). Thus, a greater level of accessibility to facilities was linked with greater knowledge, more positive attitudes, and more pro-environmental reported behavior. Figure 2 illustrates these relationships.

3.7. Additional Findings

• Gender—No significant differences were found between males and females in relation to their level of knowledge, reported behavior, and level of awareness regarding the accessibility of facilities near to their place of residence. However, significant differences were found between males and females regarding their attitudes to the environment (t₍₃₁₉₎ = 4.33, p < 0.001), with women having more positive attitudes compared to men (averages of 3.95 vs. 3.65, respectively).
• Age—The older the participants, the more positive their attitudes to the environment (r_p = 0.15, p < 0.01), the more pro-environmental their reported behavior (r_p = 0.20, p < 0.001), and the greater their level of awareness regarding the accessibility of facilities near to their place of residence (r_p = 0.12, p < 0.05).
• Level of religiosity—No significant differences were found between the levels of religiosity in relation to the study variables.
• Number of people living in the household—The more people there were living in a household, the less pro-environmental their reported behavior (r_p = −0.22, p < 0.001).
• Level of education—The higher the level of education, the more positive the attitudes to the environment (r_s = 0.14, p < 0.05), the higher their level of knowledge (r_s = 0.28, p < 0.001), and the more pro-environmental their reported behavior (r_s = 0.11, p < 0.05).
• Pet ownership—Significant differences were found between participants who currently owned pets or who had owned pets in the past and participants who hadn’t experienced pet ownership, in terms of both attitudes (t₍₃₁₇₎ = 3.11, p < 0.001), with the former having more positive attitudes (averages 3.37 vs. 3.15, respectively), and in terms of reported behavior (t₍₂₉₂₎ = 1.67, p < 0.05), with participants who had owned pets reporting more pro-environmental behavior (averages 3.39 vs. 3.28, respectively).

3.8. Regression Model to Predict Pro-Environmental Behavior

A linear regression model was employed to identify significant predictors of pro-environmental behavior. The model incorporated variables including gender, age, knowledge, attitudes, and level of accessibility. The results are presented in

Table 5. Linear regression model results for predicting pro-environmental behavior.

Variable	B	β	p
Gender (0—male, 1—female)	0.26	0.18	<0.001
Age	0.04	0.10	0.045
Knowledge	0.24	0.26	<0.001
Attitudes	0.48	0.42	<0.001
Level of accessibility	0.03	0.09	0.071
Adjusted R Square	0.35, p < 0.001
F	32.64, p < 0.001
N	295

. The analysis revealed that several factors were significantly associated with pro-environmental behavior (p < 0.001), including being female, older age, having higher knowledge, and more positive attitudes. These were all predictors of pro-environmental behavior, and explained 35% of the model variance (p < 0.001).

3.9. How the Municipal Authority Can Help Protect the Environment

The participants were asked an open-ended question about how they thought the municipal authority could help to protect the environment. In total, 201 (62%) participants answered the question. More than half suggested that the municipal authority provide more recycling bins and that recycling bins for all types of material be made available for handling waste; twenty-seven percent suggested using information and advertising campaigns to raise awareness; twenty-five percent wanted to increase supervision and enforcement; thirteen percent wanted to have more parks and green neighborhoods; five percent wanted to have more fitness facilities and shaded walking trails; three percent suggested increasing investment in environmentally friendly equipment (such as solar-powered lanterns and traffic lights); and a similar percentage suggested the restoration of environmentally degraded areas.

4. Discussion

The attention paid to environmental issues has increased considerably in recent years, in large part due to the effects of climate change. Human activities have caused significant environmental damage to the environment, including the ozone layer [9]. The city of Ashkelon joined the Efsharibari community in Israel with the goal of promoting a healthier lifestyle among its residents. In this study, we investigated the relationship between knowledge, attitudes, and behavior in relation to health and the environment among Ashkelon residents.

Our survey results showed that the level of knowledge among Ashkelon residents regarding health and environmental issues is low (average 3.28 out of 5), despite the participants being highly educated. Nonetheless, the residents’ attitudes toward the environment are relatively positive (average 3.89 out of 5), although their reported environmental behavior is suboptimal (average 3.35 out of 5). These findings are consistent with those of earlier studies conducted elsewhere that have shown a high level of knowledge and positive attitudes among a significant proportion of the population but poor pro-environmental behavior [20,21,22,23]. A study conducted among students in Israel to assess their environmental literacy, including knowledge, attitudes, and behavior, found that most students had positive attitudes toward the environment and good awareness of the environmental situation in the country [24]. Another study found that individuals’ levels of knowledge about the damage caused to the environment by the livestock industry were low and that their attitudes about the subject were only moderately pro-environmental. This example illustrates that when individuals have low levels of knowledge about an environmental topic, their attitudes toward the environment can be negative [5].

It appears that the residents of Ashkelon strongly understood the connection between the environment and human health (77%). Nearly all the participants (94%) considered it important to preserve the quality of the environment. Additionally, many respondents mentioned feeling uncomfortable about the quantity of plastic waste they generated and expressed the belief that human behavior impacts climate change. Furthermore, it was clear that Ashkelon residents were interested in gaining additional knowledge, and seventy-two percent stated that they would consider environmental factors in their food choices if they had more knowledge about the subject. In terms of behavior, 79% reported using reusable bags, which are helpful for the environment, and most (81%) stated they regularly consume fruits and vegetables. However, they were not considering switching to a vegetarian or vegan diet, reflecting non-environmental behavior. In a study conducted by Lea and Worsley [25] exploring the beliefs and behaviors of 223 consumers in Australia, more than half of the participants agreed that environmental actions related to food are necessary to preserve the quality of the environment. Nevertheless, most of them said they were not planning to reduce their meat consumption.

In the current study, positive correlations were found between knowledge, attitudes, and behavior. The higher the participants’ level of knowledge, the more positive their attitudes to the environment and the more pro-environmental their reported behavior. These findings align with those of previous research that showed a link between acquiring environmental knowledge through educational activities and increased positive attitudes toward the environment [26]. Furthermore, it has been shown that positive attitudes are crucial in shaping responsible environmental behavior and in acquiring “environmental literacy” [27]. Other studies have reinforced this finding, suggesting the need for increased environmental knowledge to drive responsible environmental behavior, with such knowledge considered a precursor to action [28,29].

A study comparing students’ knowledge of environmental issues in developing and developed countries revealed that education is one of the most important variables that explain high levels of concern and pro-environmental behavior. It also showed that individuals with a higher level of education possess greater environmental knowledge, which is then expressed in more pro-environmental behavior [30]. Furthermore, that study found a positive relationship between attitudes and behavior, indicating that the more positive the attitude, the more pro-environmental the behavior. Attitudes were shown to affect the relationship between knowledge and behavior, reinforcing this relationship. Findings from our current study in Israel and from research conducted globally have demonstrated a strong connection between attitudes to the environment, concern about climate change, and pro-environmental behavior. This research has also shown that positive attitudes and concerns about climate change influence how environmental knowledge is reflected in environmental behavior.

A study conducted among students in Israel’s education system that assessed their environmental literacy, including knowledge, attitudes, and behavior, found that the participants reported a moderate level of knowledge about the impact of climate change and that their attitudes to the environment were to some extent positive, but that they reported suboptimal environmental behavior. Additionally, positive correlations were found between knowledge, attitudes, and behavior, whereby attitudes affected the relationship between knowledge and behavior. Moreover, the study showed that environmental knowledge alone cannot reliably predict pro-environmental behavior [14]. Some researchers have argued that having a positive attitude toward the environment is essential to encourage people to act in a pro-environmental way [15,16]. Furthermore, nurturing and expanding individuals’ knowledge of environmental issues can lead to improvements in positive attitudes toward this issue, generating responsible environmental behavior [5,31].

Positive correlations have also been found between people’s access to facilities and their knowledge, attitudes, and behavior. Thus, the greater the accessibility of such facilities, the higher the level of knowledge and the more positive people’s attitudes, the more pro-environmental their reported behavior. In a study that examined the relationship between waste usage, specifically plastic, and the awareness and behaviors of 196 students in Korea during the COVID-19 pandemic, it was found that individuals’ routine environmental behaviors during the pandemic were influenced by the environment in which they studied, and the habits acquired from their families [3]. Furthermore, previous studies reinforced this finding and showed that environmental knowledge was necessary to promote responsible environmental behavior, identifying this knowledge as a fundamental condition necessary for action.

According to the Ottawa Charter for Health Promotion [32], one of the principles needed for health promotion action is the creation of a supportive environment. This means ensuring equal opportunities and resources to enable each individual to achieve their full health potential [33]. In our study, we observed the important contribution of access to facilities to pro-environmental behavior. The more accessible the facilities were, the more positive the behavior.

We found that women, older adults, and individuals with a higher level of education had a more positive attitude toward the environment. Similarly, a survey conducted in Israel by the Social Justice Association [34] showed a connection between education level, knowledge, and attitudes toward the environment. The lower the level of education of respondents, the more they reported not considering environmental issues important. Another study involving students in Israel investigated their knowledge of the environmental effects of the chemical and petrochemical industries and the relationship between knowledge, attitudes, and behavior. If found no differences in knowledge levels between the genders. However, there were significant differences between the genders in terms of their attitudes and behavior, with women reporting more positive attitudes and pro-environmental behavior than men [14]. Wang et al. [35] found a positive correlation between aging and pro-environmental behavior. At the individual level, older people tend to engage in more pro-environmental behavior than do younger people, and at the national level, residing in a country with a large proportion of older people encourages sustainable behavior.

We found significant differences in knowledge, attitudes, and more pro-environmental behavior among participants who owned pets compared with those who did not. These findings align with those of Dopelt et al. [5]. In general, attitudes toward animals seem to influence individuals’ perceptions of the environment. Pifer et al. [36] found that in eleven out of fifteen countries, there was a connection between concern for the environment, opposition to animal experiments, and concern for animal rights.

Study Limitations

This was a cross-sectional study; therefore, no causality can be deduced from the findings. In addition, this research did not encompass all factors related to environmental behavior. Moreover, the survey was conducted among residents in the city of Ashkelon only, and the response rate was quite low, limiting the generalizability of our findings. Finally, we used convenience sampling, so statistical analysis might be biased due to the excluded participants. A high proportion of female participants and individuals in relationships may introduce bias. Sampling bias limits the generalizability of findings because it is a threat to external validity, specifically population validity. Furthermore, the research only included individuals who used computers and social media platforms. This explains the relatively young average age of the participants (41.48). Future studies should address this limitation and proactively include older populations. Another limitation may be the social desirability bias, meaning participants may have marked answers they thought the researchers wanted to receive. Finally, the study used an online questionnaire, and it may be that the subject was of concern to those who participated, creating a selection bias. Despite the limitations of the sample, the municipality of Ashkelon can learn trends in the attitudes and behaviors of the population.

5. Conclusions

We found that the residents of Ashkelon were aware of the relationship between human health and the environment. However, many respondents stated that they did not know how to recycle waste or that they were unfamiliar with the term “One Health”. On the other hand, residents with higher levels of knowledge about the environment demonstrated more pro-environmental attitudes and behavior. Participants who owned pets also showed more knowledge, pro-environmental attitudes, and pro-environmental behavior. Therefore, it is important to recommend that people adopt pets. There is also a need for comprehensive public education on environmental topics and how individuals’ conduct contributes to environmental damage.

The city of Ashkelon can potentially reduce environmental damage by implementing recycling stations and educating the population to change their consumption patterns and diets [17]. Like many cities worldwide, the municipality of Ashkelon understands the need to participate in the global effort to address the climate crisis. Examples of cities tackling climate change are Bogota (Urban Transportation), Copenhagen (Carbon Measurement and Planning), Melbourne (Energy Efficient Built Environment), Mexico City (Air Quality), Munich (Green Energy), New York City (Adaptation and Resilience), Rio de Janeiro (Sustainable Communities), San Francisco (Waste Management), Singapore (Intelligent City Infrastructure), and Tokyo (Finance and Economic Development) [37]. The municipality of Ashkelon is learning from various cities and planning different types of projects.

This study’s findings can help support municipal policy- and decision-making. Policymakers can utilize research to design targeted educational campaigns aimed at dispelling common misconceptions about climate change. These campaigns should emphasize the urgency of individual action and highlight the tangible impacts of climate change on local communities. Additionally, governments can implement policies that incentivize sustainable behaviors and penalize environmentally harmful practices. This could include measures such as carbon pricing, subsidies for renewable energy, and stricter regulations on emissions.

Furthermore, research can inform the development of urban planning policies that promote sustainability and resilience. This may involve investing in green infrastructure, improving public transportation systems, and incentivizing energy-efficient building practices. Moreover, policymakers should prioritize community engagement and participation in decision-making processes related to climate action. By involving residents in the planning and implementation of policies, governments can foster a sense of ownership and collective responsibility for addressing climate change.

The residents of Ashkelon exhibited limited knowledge regarding the environmental effects of failing to recycle plastic. Most people had not considered adopting a vegetarian or vegan diet, indicating the need for campaigns and workshops to raise awareness around this subject. We would expect such initiatives to be effective, especially as we found that knowledge was positively related to people’s environmental attitudes and behavior. Additionally, we found that accessibility to facilities can enhance pro-environmental behavior. Therefore, there should be more widespread distribution of recycling bins of all types throughout the city to encourage residents to help preserve the environment. Enhancing access to parks, fitness facilities, and shaded bike paths to create an environmentally supportive environment is also recommended.

Regarding education, raising awareness of the relationship between human behavior, health, and the environment should be addressed through intervention programs and education for individuals and the community. Increasing the supervision and enforcement of the municipality in this matter and transforming Ashkelon into an environmentally friendly city by investing in environmentally friendly equipment is essential (e.g., recycling stations, sports facilities, walking trails, etc.). These objectives can be achieved through collaboration among various city departments, residents, the Ashkelon Academic College, the Ministry of Environmental Protection, the Ministry of Health, environmental advocacy organizations, and other stakeholders. We also recommend conducting this survey in other Israeli cities to obtain comprehensive data about the environmental knowledge, attitudes, and behaviors of all Israeli citizens. The intervention programs and all actions to be taken can be assessed based on models for evaluating health promotion interventions, including process evaluation, short-term assessment, and long-term assessment through pre–post surveys, environmental assessment, analyses of council meeting protocols, etc.