ISRAEL AT WAR - DAY 145

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Health Ministry launches new plan to stub out worrisome rise in Israeli smoking

With 8,000 deaths per year tied to tobacco and increasing numbers of youth taking up vaping, special task force offers a dozen recommendations to address problem

Renee Ghert-Zand is the health reporter and a feature writer for The Times of Israel.

Illustrative. Cigarettes in an ashtray, October 17, 2016. (Nati Shohat/Flash90)
Illustrative. Cigarettes in an ashtray, October 17, 2016. (Nati Shohat/Flash90)

The Health Ministry announced on Monday a multi-pronged action plan to combat smoking and reduce related deaths and illnesses. The plan, addressing all tobacco and electronic cigarette products, has been published and is available for public comment.

The plan comes at a time when smoking is taking an increasing toll on Israeli public health, as the use of both cigarettes and e-cigarettes (vapes) has risen in recent years, after decades of a downward trend.

The proposed program takes a variety of tacks against smoking, the most marked being a recommendation that the legal age for the purchase of all smoking products change from 18 to 21. Other recommendations relate to product content; labels and warnings; taxation; import and sales restrictions; and education and legal enforcement. It is the work of a national task force appointed by the Health Ministry in May to deal with the problem.

The task force consulted with many relevant experts and organizations, including physicians, government ministries, civic groups, parents’ groups, academic researchers and youth representatives.

“The fight against smoking requires a complex and joint effort, and we are committed to carrying out the policies in a variety of areas of smoking prevention and cessation to advance public health,” said Health Minister Moshe Arbel.

The Israel Cancer Association (ICA) praised the proposed comprehensive reform, saying it was a step in the right direction, but warned that it requires sufficient resources to succeed.

“The time has come for a real and dramatic change in resource investment in the fight against smoking. A designated unit should be established within the Health Ministry that will ensure that the policies are carried out,” said ICA health promotion specialist Dana Frost.

Disposable e-cigarettes (Courtesy of the Israel Cancer Association)

The anti-smoking action plan calls for banning all flavored smoking products, enforcing the permitted amount of nicotine in e-cigarettes and limitations on the amount of vaping liquid permitted for import, marketing, and sale. The plan also calls for clear, graphic warning labels and visual uniformity for all smoking and vaping products and packaging.

The task force presented four recommendations concerning the sale of smoking products: prohibiting of single-use vapes; limiting the sale of tobacco and smoking products to select designated retail outlets; raising the legal age for the purchase of smoking products to 21; and the provision of authority to the Health Ministry to enforce the ban on advertisement of smoking products via the internet.

Finally, the action plan includes several recommendations regarding the introduction or increase of taxation on nicotine and smoking products of all kinds.

As reported earlier this summer in The Times of Israel, smoking is a major public health concern in Israel. Eight thousand Israelis die from tobacco use every year, 800 of them from passive smoking. After several decades that saw a downward trend in smoking, more Israelis are now either using combustible (tobacco) cigarettes or e-cigarettes. Both types contain nicotine, which is highly addictive.

Teens smoking electronic cigarettes (iStock)

According to a report by the Taub Center for Social Policy, as of 2020, the smoking rate among the Israeli adult population aged 21 and older is 20 percent — higher than the OECD average. A quarter of men and 15% of women smoke, with rates higher among Arabs than Jews. The COVID-19 pandemic made things worse, with one-quarter of smokers adding 13 more cigarettes on average to their daily routine.

A report on smoking issued by the Health Ministry in 2021 stated that after a significant drop-off in youth smoking between 1998-2019, the trend is reversing. Presently 20% of youth (more boys than girls) smoke, with half of them smoking tobacco and half using e-cigarettes. Whereas, in the past, teens were initially introduced to smoking through cigarettes and hookahs, by 2019, they were reporting more use of vapes, some as early as age 12. Vaping is widely seen by health experts as a gateway to tobacco smoking.

According to ICA’s Frost, the bright colors and appealing sweet and fruity flavors of vapes — especially the cheap single-use ones — are getting kids hooked.

“It’s illegal in Israel to sell smoking products to minors. Yet, kids in middle school are getting ahold of them,” Frost said.

Because e-cigarettes are relatively new (their worldwide use rose dramatically beginning a decade ago), there are no long-term studies on them yet. However, international peer-reviewed research presented in an ICA position paper indicates that the materials in vapes are known to expose users to heavy metals and carcinogenic chemicals.

In addition to nicotine addiction, there is evidence that vaping causes damage to the lungs and airways and the heart and blood vessels. Earlier this year, two Israeli teenage boys were hospitalized with collapsed lungs caused by vaping. One recovered, but 16-year-old Meidan Keller died, after becoming disconnected from an extracorporeal membrane oxygenation (ECMO) machine, which provides cardiac and respiratory assistance. The Health Ministry reported that the disconnection was under investigation.

A woman smokes a cigarette outside a cafe. Israel took another step towards becoming smoke-free when strict regulations came into effect that limit smoking in public places. (photo credit: Nati Shohat/Flash90)
Illustrative. A woman smoking a cigarette outside an Israeli cafe. (Nati Shohat/Flash90)

Since 2019, both cigarette smoking and vaping are legally forbidden in indoor public spaces. But even when smokers do not light up inside, it is difficult to avoid cigarette smoke outside, where many smokers assume that their actions pose no danger to others.

Fifteen years’ worth of research by Prof. Laura Rosen of Tel Aviv University has shown that people who smoke in the open air less than 10 meters from others put those people’s health at risk.

Furthermore, smoking outside does not necessarily protect the health of non-smokers inside a building. A peer-reviewed study published this past February by Rosen showed that six out of 10 children whose parents restrict their smoking to their home’s porch or yard had nicotine that circulated in their bloodstream and ended up deep in their hair shafts.

Attorney Amos Hausner, chair of the Israeli Council for the Prevention of Smoking, has brought an administrative lawsuit before the Supreme Court on behalf of the Citizens for Clean Air organization and several individuals demanding protections against smoke incursion from neighbors’ apartments and the enforcement of the 2008 Clean Air Act.

“Fifty percent of the population in Israel is exposed to secondhand smoke from their neighbors. It’s especially a problem in lower-income areas,” Hausner said.

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