Inside Story'In some ways, we are letting people get addicted'

Stressed out by war, Israelis appear to be smoking more than they have in years

Soldiers, hostages’ families and others seem to be lighting up at increasing levels, reversing years of falling rates, but health experts aren’t pushing them to kick the habit yet

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

A woman passes a cigarette during a protest calling for the release of the people held  hostage by Hamas terrorists in Gaza, outside the Defense Headquarters in Tel Aviv, November 3, 2023. (Avshalom Sassoni/ Flash90)
A woman passes a cigarette during a protest calling for the release of the people held hostage by Hamas terrorists in Gaza, outside the Defense Headquarters in Tel Aviv, November 3, 2023. (Avshalom Sassoni/ Flash90)

With Israel anxiously fighting a war and dealing with the after-effects of the October 7 massacre and hostage crisis, it is little surprise that increasing numbers of people appear to have turned to smoking.

With much of the population affected by either the war, hostilities in the north, rocket attacks, having loved ones in military service, or involved in the fighting themselves, life in Israel can feel more stressful than it ever has. According to public health experts, when stress levels surge, so do rates of people taking on the unhealthy, addictive habit of lighting up.

“We are in such a challenging time,” said Prof. Hagai Levine, chairman of the Israel Association of Public Health Physicians. “The cigarette is not our friend. We don’t need it. But I totally understand that we also have other priorities and considerations.”

While it is too early for more than sparse data on increasing tobacco use, experts point to strong anecdotal evidence that smoking rates have risen since October 7. Researchers affiliated with universities and non-profit organizations say they plan to collect updated data to determine whether the impression of increased smoking bears out statistically once circumstances allow.

“As far as I know, we don’t have data [yet] from this war. But data from elsewhere in the world shows that whenever conflict or an event leads to a public mental health crisis, there is a rise in smoking,” said Dr. Yael Bar-Zeev of the Braun School of Public Health and Community Medicine at the Hebrew University of Jerusalem-Hadassah Medical Center.

Levine said data from previous Israeli wars and military operations “show that, many times, there is an increase in addictive behaviors and smoking.”

According to Bar-Zeev, much of the uptick is not in new people picking up the habit, but in existing smokers reaching for more and more cigarettes or vape cartridges as a coping mechanism.

Dr Yael Bar-Zeev of the Braun School of Public Health and Community Medicine at The Hebrew University of Jerusalem -Hadassah Medical Center. (Courtesy)

“I did a few surveys during COVID that showed that during that time of distress, anxiety, and uncertainty, there was about a 30 percent increase in smoking among smokers,” she said.

A limited survey conducted early in the war by Maccabi Healthcare Services, Israel’s second-largest health maintenance organization, found that 56% of self-reported smokers shared that they were smoking more.

Another limited survey of smokers conducted by Prof. Ido Wolf, director of the oncology division at Tel Aviv Sourasky Medical Center-Ichilov Hospital, had 65% of respondents admitting to smoking more since October 7.

According to Shira Kislev, CEO of Smoke Free Israel, a non-profit organization focused on preventing smoking among children, adolescents, and young adults, those who smoked in the past, but managed to kick the habit are likely to start lighting up again to deal with tough times, as her organization’s surveys showed during the COVID-19 pandemic.

Shira Kislev, CEO of Smoke Free Israel (Chen Galili)

Kislev said that smoking rates were already rebounding before the war, after falling for several years, and she expects it to continue rising in 2024, though she cannot know for sure until new data is collected and analyzed over March and April.

“Our organization does its annual sample surveying of the Israeli population every spring. We break the smokers down into groups according to age and smoking frequency,” Kislev said.

“The percentage of adults who were daily smokers in 2019 was 24.7%. Then there was a downward trend to 21.4% in 2020, 18.3% in 2021, and 17.9% in 2022. However, the rate was back up to 21.3% in 2023,” she said.

Smoke Free Israel monitors the use of traditional cigarettes, e-cigarettes (vapes) and associated liquids, roll-your-own cigarettes, shishas (also known as nargilehs, waterpipes, and hookahs), and heated tobacco products. Other tobacco products, like cigars, dipping tobacco, snus and snuff are not looked at.

“Adults older than 40 generally smoke cigarettes. Between the ages of 20 and 40, roll-your-own cigarettes are popular, and e-cigarettes are popular among teenagers,” Kislev said.

Smoke Free Israel’s data shows a significant bump in the number of smokers aged 18-20 as compared to 15-17, which is expected when the legal age for the sale of smoking products is 18.

Cigarettes in an ashtray on April 10, 2021.(Nati Shohat/Flash90/File)

It is also the age when most are conscripted into the army, which is when many pick up the habit.

With hundreds of thousands of reserve soldiers called up, some surmise that the war effort itself has been a factor in sending smoking rates wafting upward.

Unlike in wars in earlier decades, the Israel Defense Forces does not distribute cigarettes to the troops, but plenty nonetheless made it to various units alongside snacks, clothes, equipment and other gear donated by those looking to bolster the war effort or their own bottom line.

“We don’t have the actual data yet, but we know from anecdotal evidence and reports from the field that a lot of tobacco [products] have been distributed among reserve soldiers that were going into the battlefield,” Bar-Zeev said. “Some of it came from donations from [individual] people, but a lot of it came from donations from the tobacco companies.”

“We have heard that as a result of the cigarette donations, a lot of soldiers have either gone back to smoking or have started smoking,” she said, pointing a finger at the high number of products donated for marketing purposes.

Teenagers vaping in a park. (iStock)

Kislev emphasized that initiation and addiction to smoking usually happen up to age 24, with the riskiest age group being 18 to 24, the cohort that conscripts and young reservists fall into.

The Times of Israel reached out to Philip Morris, the largest cigarette company in Israel, for comment but no one answered the phone at its Tel Aviv office. In addition, the Health Ministry did not respond to an email inquiry regarding smoking during the war.

Levine said troops he had spoken to who had gone back to smoking cited stress relief during long hours in between combat as a motivating factor.

But he noted that tobacco use does not actually relieve stress and has a detrimental effect on a soldier’s health in the short term as well as down the line.

“Furthermore, smoking interferes with a soldier’s readiness,” he added. “If you are in a stakeout and smoke, your light could be revealed. If you are not smoking a cigarette and your body is craving nicotine, you’re less focused. A professional soldier wanting to do their best should avoid starting to smoke in the first place.”

IDF soldiers operating in the Gaza Strip, in a picture released on March 20, 2024. (Israel Defense Forces)

Levine, who leads the medical and resilience group within the Hostages and Missing Families Forum, reported that he had also seen a return to smoking among relatives of captives and forum volunteers.

A self-reported survey Levine and his team did to assess the health of the families and volunteers showed that they were under enormous stress and suffering a decline in their overall health, including an increase in smoking.

“We saw this from our survey and I also have the personal impression that there is heavy smoking. This is from my observation of being with the families,” Levine said. “Some of these people returned to smoking after having quit years ago.”

Prof. Hagai Levine, head of the medical and resilience committee of the Hostages and Missing Families Forum (right), speaks at a Knesset Health Committee meeting, March 4, 2024. (Knesset livestream screenshot)

There has also been a relaxation of attitudes shunning smoking in public in deference to those going through tough times, Levine said, which can be seen at rallies for the hostages in Tel Aviv and elsewhere.

Although he generally does everything possible to avoid exposing himself to secondhand smoke, Levine shared that he has had to be flexible during the national crisis, including accompanying traumatized individuals as they light up.

“According to the law, people are not supposed to smoke at a mass gathering, including an open-air one,” he said. “But how can you say to a [hostage’s] family member, who is under such stress, not to smoke here? Without being judgmental, I’m just saying that this is becoming more common.”

Protesters call for the release of Israelis held kidnapped by Hamas terrorists in Gaza, at Hostages Square in Tel Aviv, February 10, 2024. (Avshalom Sassoni/ Flash90)

But he noted that being more flexible did not make secondhand smoke any less dangerous.

“I treated a pregnant family member who collapsed at a rally after being exposed to heavy smoke, which seemed to be from a mix of tobacco and cannabis,” he recalled. “She felt very bad and nearly lost consciousness.”

Kicking butts

Experts whom The Times of Israel spoke to insisted that most smokers want to quit. They believe that with the right support and resources, increased taxation, and enforced legislation, it will be possible to help all those who want to cease smoking.

According to Bar-Zeev, she and other tobacco control professionals have deliberated together whether to talk now with soldiers, about something that may kill them decades in the future, when they are heading into battle and fear they will not be alive tomorrow.

Bar-Zeev said that, even though “in some ways, we are letting people get addicted,” she is in favor of waiting to help soldiers, hostage families, and others kick the habit.

But she suggested that the IDF could already distribute nicotine patches to soldiers who smoke so that they get the chemical hit they need without lighting up.

Illustrative: A man applies a nicotine patch. (Henadzi Pechan via iStock by Getty Images)

Levine said that some of the hostages’ family members promised they would quit smoking once their loved ones are back home.

“I hope this relief will lead to smoking cessation and that these people will keep their promise to themselves,” he said. “Unfortunately, we’re not there yet.”

In terms of the troops, Levine suggested that a quitting hotline could be set up and personal counseling arranged for when they finish their service.

“As I see it, it is our obligation to protect their lives,” he said, referring to health damages caused by smoking. “Not when they are in Gaza, but after. We must help those who have risked their lives for us.”

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