International No-Smoking Day took place in Israel and around the world on May 31, but an unscientific poll three days after the event revealed that most Israelis were unaware that such a day exists. Activities related to smoke-prevention were held throughout the country during the week of May 27 to June 1, leading up to and following International No-Smoking Day. Some attracted media attention, but most of the low-profile, scattered events did not. It appears that the Israeli public is generally nonchalant about this issue, or too overwhelmed by other issues to be proactive. At the same time, some new grass-roots activity and a bill expected to be passed in the coming weeks may mark the beginning of a new era relating to smoking in public places. An organization called Linshom Naki ("To breathe fresh air") kicked off the week on Sunday, May 27 by announcing a demonstration to take place the following Friday in front of Dizengoff Center to protest the passive smoking at the Tel-Aviv shopping mall. Linshom, although it has scores of active members, refuses to register as an official organization. They do no fund-raising and have minimal expenses, with operations including mainly e-mail activity, collecting signatures for petitions and filing lawsuits against establishments that do not enforce the law for preventing smoking in public places. Linshom members have recently developed a new form of protest: They visit public places such as restaurants and pubs in large groups, demanding that the managers create a smoke-free environment. One such outing was recently documented by a YNET video photographer and consequently won some media attention. The group's proponents are thrilled that the burning issue of passive smoking is finally gaining some public attention and serious action. While detractors say that Linshom's actions are provocative and crass, the group's activists retort that the rude behavior is that of smokers who do not respect the public's right to breathe clean air. Individual citizens are forced to face each other in spontaneous stand-offs between smokers, non-smokers and businesses (that often claim they are caught between a rock and a hard place). Interestingly, all parties seem united in their view that this matter ought to be handled by the authorities, be it municipalities, police or the state. They share frustration that they are forced to work this out themselves, rather than have the appropriate authorities deal with the issue. As the potential benefit of lawsuits pushing for implementation of the anti-smoking law becomes clearer, Linshom is no longer the only group encouraging citizens to file lawsuits. The Israel Cancer Association and the Ramat Gan Law School jointly created a hotline providing free advice to individuals wishing to sue businesses in relation to this law. The hotline operated for two weeks only as a pilot project, staffed by students from the law school who answered questions and helped file lawsuits in small claims courts. The service's organizers reported that 100 calls were received during the hotline's first week. Another new pressure group is the Israeli College of Physicians for Smoking Prevention and Cessation, founded about one year ago by a group of physicians from different fields who believe that awareness is lacking among Israeli doctors regarding smoking cessation, compared to the situation in the US and UK. They are concerned that there are no established criteria for the training and approval of therapists, this lack of an official authority has created a vacuum that is rapidly filling with commercial and private interests, and without any safety monitoring or control. The new organization is comprised of doctors, nurses, health professionals and researchers who work in the field of smoking prevention and cessation in Israel. The organization aims to unite the professionals, make known a set list of clinical guidelines, advance research in this field and have it recognized as an official professional field, and to become a member of the Israel Medical Association (IMA). On May 29, several relevant organizations co-sponsored the first-ever "National Conference for the Prevention and Cessation of Smoking" at Kfar HaMaccabiah, attended by representatives of the health ministry, the Israel Cancer Association (ICA), the Maccabi, Clalit and Meuhedet health funds, and the Medical Organization for Prevention and Cessation of Smoking in Israel. "Israelâ€¦ will conduct an all-out war against smoking, the leading cause of death in the world," Health Minister Ya'acov Ben-Yizri told the conference. "The Health Ministry will do everything in its power to increase enforcement against smoking in public places (and) continue legislative work on issues presented in the World Health Organization Framework Convention of Tobacco Control." ICA chairwoman Miri Ziv added, "On this day, we call upon the many smokers who wish to kick the habit to use this special date to quit smoking. You have the power to substantially reduce your risk of becoming ill." Among the many lectures presented that day were two relating to smoking in minority groups: Fathan Jettas of the ICA and Doctor Muhamad Najami of the Clalit health fund discussed smoking in the Arab sector. A. Lubitz of the Haviv organization, a Haredi group whose aim is to prevent smoking in the Haredi community, discussed smoking in this sector. Mr. Lubitz noted similarities he found between smoking and quitting patterns in the Haredi and Arab communities. The following day, the Knesset's Finance Committee held a session focusing on the bill proposing stronger enforcement of the existing law that prohibits smoking in public places, including raising fines for illegal smoking from NIS 310-630 to NIS 1,000-5,000. This new bill was initiated by MKs Gilad Erdan (Likud) and Yoel Hasson (Kadima) late last year, and passed its first Knesset vote. The committee meeting prepared the ground for the bill's second and third reading in the Knesset. Half of the sections were approved, and the bill in its entirety is expected to be approved by the committee at its next meeting later this month. After this approval, the bill is expected to be approved in a Knesset vote before the parliament disperses for its summer break in late July. Asked by Metro how he became involved with this law, Erdan explained, "I quit smoking about two years ago. When my wife gave birth I began to notice how irritating it is when people smoke near us, and how uncomfortable it is to have to ask smokers to stop (smoking near them). I did not understand why businesses were not enforcing the law." Approximately one year ago, Jerusalem-based attorney Amos Hausner approached Erdan and explained the legal aspects of the issue of smoking in public places. Says Erdan: "I understood the subject, and said I'm on board in this struggle. In addition to the health value involved, this project has an educational value, too: People need to understand that they must act with consideration toward one another." On the morning of International No-Smoking Day, there was no special mention in Israeli newspapers, save for advertisements by the Green Party and the Israel Cancer Association. Quietly, with little or no media coverage, quite a few activities took place around the country. According to Health Ministry data published that day, the percentage of cigarette smokers among the general Israeli public has remained steady over the past few years, with 26.6 percent of men and 19.7% of women smokers. Health Minister Ya'acov Ben-Yizri told the media that he plans to propose a bill to raise duty on cigarettes and limit placement of cigarette vending machines. The Israel Cancer Association (ICA) sponsored a variety of activities throughout the country. Information booths were set up in many cities, with pamphlets and other material regarding smoking handed out to passersby. Locations included the Beersheba train station, Tiberias, Tel Aviv train station, Ichilov Hospital, Haifa, Kfar Saba and others. Some of these stands were set up in cooperation with the IDF, local municipalities and/or the health funds. A national school artwork competition was held: Schools from all over Israel created posters and other art work relating to the risks associated with smoking. A select group of pupils from several schools attended the project presentation and awards ceremony at the ICA headquarters in Givatayim. Among the participating schools were Ben-Gurion School (Ramat Gan), Ibn Khuldun (Nazareth, both elementary and high school students), Keshet high school (Jerusalem) and Shaffi (Baka al-Gharbiya). The pupils had obviously invested much time, attention and energy on their projects. Some schools prepared computerized presentations. Others presented song and/or dance performances. All participating schools run ongoing anti-smoking programs throughout the year. ICA-trained lecturers hold in-school lectures all over Israel throughout the year, to educate children and youth on the risks associated with cigarette smoking. This activity was strengthened around May 31, to gain the momentum provided by the special date. That evening, in an effort to publicize a Teva medicine called "Spiriva" developed to treat Chronic Obstructive Pulmonary Disease (COPD), Teva and the Israel Society of Pulmonology sponsored a smoke-free party at the Haoman 17 club in Tel Aviv. Celebrities who attended included MK Yoel Hasson, Advocate Ilan Bombach, TV journalist Yigal Ravid, radio journalist Itai Ben-Nissim and chef Yisrael Aharoni, who served as the party's DJ. Smokers who attended the party said they are used to being able to smoke inside clubs, pubs and restaurants. Some said it's nice to have clean air and that they don't mind stepping out when they need a cigarette. Others, however, complained about the new order. A bartender who asked to remain anonymous, said it's difficult psychologically, "just knowing you can't have a cigarette." Surrounded by fresh air and very loud music, a young smoker named Hagit added: "this is different, and difficult." Her friend Sharon, a non-smoker, enjoyed the smoke-free environment and wished this idea would be implemented in other places. "People in Israel think (enforcing the law) will cause people to stop going out. This is nonsense. New York (entertainment places, where smoking is prohibited indoors) is filled with people," she told Metro. One hour later than in the Cinderella story, the magic at this party began to fade. The club, that had entertained mainly people invited specifically for the smoke-free event, began to fill with smoking guests. The newcomers had no intention of experimenting with ideas that interfere with their smoking habits, and according to non-smokers at the party, the club officials refused to ask the smokers to put out their cigarettes. And yet, for a brief few hours non-smokers had the unusual pleasure of breathing clean air at a nightclub in Israel. As they promised earlier in the week, Linshom members sponsored a small but visible demonstration in front of Dizengoff Center at midday Friday. The demonstrators wore white, symbolizing the smoke-free air they wish to breathe. They carried signs protesting smoking in the shopping mall, and asked passersby to sign a petition supporting strict enforcement of the law prohibiting smoking in public places. The demonstrators also complained that ashtrays in the shopping center encourage smokers to smoke there. Organizers say 100 or so people attended the demonstration. Toward the end of the rally, the general manager of the mall's management company, Rafi Finkelstein, invited Linshom representatives into his office for an impromptu meeting. Guy Ophir, a 28-year-old attorney who attended the meeting, told Metro: "Aside from a specific promise to enable us to act as self-appointed "smoke-inspectors," we were given no promises for specific action (by the mall). Therefore, the assurance we were given does not satisfy us, and we intend to continue to pressure Dizengoff Center to enforce the law." After the demonstration, Finkelstein told Metro that he believes smokers should only smoke in the two designated smoking areas in the mall. At the same time, he claimed Linshom should have tried to speak with him directly, instead of holding a demonstration against Dizengoff Center. "The law provides me with no real tools to deal with this issue," Finkelstein said, insisting that he nonetheless does his best to enforce the law. He added that he supports taking action that would have a greater impact than just asking individual smokers to put out their cigarettes. When asked what would constitute "greater impact action," his immediate response was "their demonstration is a good thing." Himself a non-smoker, Finkelstein seemed genuinely sympathetic of Linshom's campaign and described the center's efforts and difficulties with the smoking issue. Yet just 20 meters from the manager's office, four smokers stood smoking peacefully on the "Children's Bridge" where several young children were playing. A "no-smoking" sign hangs on either end of the bridge. Three days after the Friday demonstration, Linshom's Noam Pelled won a lawsuit he filed against Dizengoff Center in a small-claims court, regarding the mall's failure to enforce the no-smoking law. Perhaps these encounters best reflect the difficulty surrounding enforcement of the law in Israel. Insufficient awareness on the part of smokers and non-smokers alike, coupled with a growing frustration on the part of passive smokers, has led to increasing levels of grass-roots action and lawsuits against restaurants and shopping malls. The week's activities may not have been very visible to the general public in Israel. However, it may turn out we are in the midst of a small but significant legal and social change in smoking habits in Israel. What are the municipalities doing? Ashkelon: City spokeswoman, Anat Berkowitz: "In an effort to raise awareness, a flower and Israel Cancer Association information on smoking were given to smokers at shopping malls on International No-Smoking Day, instead of fines. Ashkelon's department of municipal inspection has been enforcing the law prohibiting smoking in public places for about two years now, ever since inspectors were trained and authorized to enforce the law." Carmiel: The city's spokeswoman, Leviya Fisher, says enforcement is mainly in the city's two closed shopping malls. According to Fisher, approximately 130 people were fined in 2006. She says Carmiel was among the first municipalities to enforce the law, but admits people do still smoke in the shopping malls, and says, "awareness is growing, but there is still much work to be done." Haifa: 505 people were fined in 2006, mainly in the city's hospitals. Information was distributed in cooperation with the Israel Cancer Association. Herzliya: Mayor Yael German declared Herzliya a "smoke-free city." She has authorized 12 more inspectors to enforce the law prohibiting smoking in public places. They join the 23 inspectors previously trained for this purpose. On International No-Smoking Day, information on smoking was distributed to the general population by the municipal health division. Jerusalem: City spokesman Gidi Schmerling writes: "All year, the city's education administration runs a variety of programs in the struggle to fight smoking among students in Jerusalem schools. There is a "youth parliament" against smoking, made up of pupils. The children, of varying ages, visit city schools and discuss this issue. In addition, the Jerusalem municipality works to enforce the law prohibiting smoking in public places, and all the city's inspectors have been authorized to fine [those who break the law.] There were 781 fines in 2006, and 703 in 2007, so far." Ramat Gan: A February 14, 2007 press release by the municipality's spokesperson, Memi Pe'er, says "935 people were fined in 2006." Pe'er's office told Metro that two inspectors are stationed in Tel Hashomer hospital, and two in the Ayalon shopping mall. Ra'anana: An official response from the Ra'anana municipality reads as follows: "The Ra'anana municipality works year-round to enforce the law prohibiting smoking in public places. Its inspectors patrol the city and fine smokers who smoke in prohibited areas." Tel-Aviv: In an initial telephone conversation with the spokesperson's office, an employee told Metro she had not heard of International No-Smoking Day, and therefore it's unlikely that any activities were sponsored by the municipality that day, adding "If there was anything, I would have heard about it." Upon further insistence, Metro received the following written response from municipality spokesman Hillel Partuk: "The Tel Aviv-Jaffa municipality enforces the smoking law within the framework of the existing personnel and according to a division of resources between the different inspection tasks in the city. Being that the state has not allotted funds for the enforcement of this law, enforcement activities focus on handing out warnings, posting signs in eating establishments and enforcement against smokers at Ichilov Hospital. In 2006, approximately 206 fines were presented to people smoking in public places. In the near future, the municipality is preparing to increase enforcement, in a gradual manner, in shopping malls around the city." Only after a third or fourth query by Metro, did an employee in the spokesperson's office provide an extremely vague and general response regarding specific activities on International No-Smoking Day. "There was increased activity in the shopping malls that day," she said, "Approximately 30 people were fined." Tiberias: On International No-Smoking Day, Israel Cancer Association material was distributed throughout the city, in health fund clinics and schools.