Researchers: Leah Rosen¹, Vaughan Rees², Yael Bar Zeev³, Geoff Fong⁴, Shannon Gravely⁴, David Steinberg¹

Background: Tobacco use and exposure remains the leading cause of premature death in Israel and globally.

Objectives: To assess use of and knowledge about tobacco products; to understand smoker preferences for messages in tobacco package inserts; to evaluate the Framework Convention on Tobacco Control (FCTC) policies in collaboration with the International Tobacco Control Policy Evaluation (ITC) Project.

Method: The telephone survey was conducted in the spring of 2022, based on a representative sample of the adult population in Israel (18+), and weighted for population characteristics. Included were 659 respondents, with a response rate of 62%. The qualitative study included 25 smokers and former smokers, aged 18-67.

Findings: Three-quarters of respondents supported raising the legal age of tobacco sales from 18 to 21, 82% supported graphic health warnings on tobacco packs, and 89% supported banning smoking in common areas of multi-unit buildings. Tobacco smoke incursion into private homes affected nearly 40% of respondents, with those with above average income experiencing substantially less incursion. Knowledge about harms has increased since 2010, but remains partial. There is confusion regarding e-cigarettes and IQOS. Just one fifth of the population has a good understanding of when exposure occurs. Nearly 3/4 of respondents were exposed to tobacco smoke.

Conclusions: Strong action is needed to decrease tobacco use and exposure, and to allow Israel to once again be a leader in tobacco control.

Recommendations: • Legislation to increase the minimum age of tobacco sales from 18 to 21, for graphic health warnings on tobacco packages, and for making common areas of multi-unit dweller buildings smoke-free, should be advanced immediately.
• Tobacco package inserts, mandated by the Knesset in 2018, should be implemented quickly using the information from this study.
• Individuals need governmental protection from tobacco smoke incursion into private homes. The current Supreme Court case on Neighbor Smoking (1416/21 )could allow this, and affords an excellent opportunity for Israel to become a world tobacco control leader.
• Exposing others to tobacco smoke needs to be completely denormalized in Israel.
• Monitoring should continue in the context of the ITC Project.

Research end date: 05/2023